AMERICAN HEALTH PRIMERS. 

Edited by W. W. KEEN, M.D., 

Fellow of the College of Physicians of Philadelphia; Surgeon to 
St. Mary's Hospital, etc. 



It is one of the chief merits of the Medical Profession in modern times that its mem- 
bers are in the fore-front of every movement to prevent disease. It is due to them that 
the science of what has been happily called " Preventive Medicine" has its existence. 
Not only in large cities, but in every town and hamlet, the Doctor leads in every effort 
to eradicate the sources of disease. These efforts have been ably seconded by intelli- 
gent and public-spirited citizens of many callings. The American Public Health Asso- 
ciation and the Social Science Association, with their manifold and most useful influ- 
ences, are organiz aficgis w hich have sprung from, and still fur ther e xten^ and reinforce, 
the efforts to imj ' "" 

But the great i 



LIBRARY OF CONGRESS. 



%p. 



sr 




UNITED STATES OF AMERICA 



Z^i^ 



jch efforts, or, 
e, and of their 
ion of disease. 

a direct result 
the object of 
>ly as possible, 
Medicine, and 
anch of Medi- 
:ssist in curing 

, their pupils, 

1 reference to 



, fee respects we 



if they do, are i§ 
practical applici^ 
Such knowledge 
of the most lab( 
this series of An 
among all class 
the bearings and 
cal and Hygieni- 
disease, but to te 
and their emploi 

The series is 
our Climate, An 

differ materially from other nations. Sanitary Legislation especially, which in England 
has made such notable progress, has barely begun with us, and it is hoped that the 
American Health Primers may assist in developing a public sentiment favorable to 
proper sanitary laws, especially in our large cities. 

The subjects selected are of vital and practical importance in every-day life. They 
are treated in as popular a style as is consistent with their nature, technical terms being 
avoided as far as practicable. Each volume, if the subject calls for it, will be fully 
illustrated, so that the text may be clearly and readily understood by any one hereto- 
fore entirely ignorant of the structure and functions of the body. The authors have 
been selected with great care, and on account of special fitness, each for his subject, by 
reason of its previous careful study, either privately or as public teachers. 

Dr. W. W. Keen has undertaken the supervision of the series as Editor, but it will be 
understood that he is not responsible for the statements or opinions of the individual 
authors. 



The following volumes are in press, and will be issued about one a month, 

I. Hearing, and How to Keep It, 

By CHAS. H. BURNETT, M.D., of Philadelphia, 

Consulting An7-ist to the Pennsylvania Institution for the Deaf and Dumb , 
Aurist to the Presbyterian Hospital, etc. 

II. Long Life, and How to Reach it, 

By J. G. RICHARDSON, M.D., of Philadelphia, 

Professor of Hygiene in the Lmversity of Pennsylvania, etc. 

III. Sea-Air and Sea-Bathing, 

By WILLIAM S. FORBES, M.D,, of Philadelphia, 

Surgeon to the Episcopal Hospital, etc. 

IV. The Summer and its Diseases, 

By JAMES C. WILSON, M.D., of Philadelphia, 

Lecturer on Physical Diagnosis in fefferson Medical College, etc, 

V. Eyesight, and How to Care for It, 

By GEORGE C. HARLAN, M.D., of Philadelphia, 

Surgeon to the Wills {Eye) Hospital. 

VI. The Throat and the Voice, 

By J. SOLIS COHEN, M.D., of Philadelphia, 

Lecturer on L' is eases of the Throat in fefferson Medical College. 

VII. The Winter and its Dangers, 

By HAMILTON OSGOOD, M.D., of Boston, 

Editorial Staff Boston Medical and Surgical fournal. 

VIII. The Mouth and the Teeth, 

By J. W. WHITE, M.D., D.D.S^, of Philadelphia, 

Editor of the Deiital Cosmos. 

IX. Our Homes, 

By HENRY HARTSHORNE, M.D., of Philadelphia, 

Formerly Professor of Hygiene in the University of Pennsylvania, 

X. The Skin in Health and Disease, 

By L. p. BULKLEY, M.D., of New York, 

Physician to the Skin Depart77zeni of the Demilt Dispensary and of the 
New York Hospital, 

XI. Brain Work and Overwork, 

By H. C. WOOD, Jr., M.D., of Philadelphia, 

Clinical Professor of Nervous Diseases iii the University of Pennsylvania, etc. 

Other volumes are in preparation, inchiding the following subjects: "Preventable 
Diseases," "Accidents and Emergencies^" '• Tov/ns we Live In," "Diet in 
Health and Disease," "The Art of Nursing," " School and Industrial Hygiene," 
" Mental Hygiene," etc., etc. They will be i6mo in size, neatly printed on tinted 
paper, and bound in cloth, 50 cents. Ivlailed free upon receipt of price. 

LINDSAY & BLAKISTON, Publishers, Phila. 



AMERICAN HEALTH PRIMERS. 



EDITED BY 



V/. V/. KEEN, M.D., 

Fellow of the College of Physicians of Philadelphia, 
AND Surgeon to St. Mary's Hospital. 



_ _ ^ 

AMERICAN HEALTH PRIMERS. 



Hearing, 



HOW TO KEEP IT. 



BY 

CHARLES H. BURNETT, M D., 

: \ 

Consuliing Aiirist to the Pennsylvania Institution for the Deaf and 

Dumb, Aurist to the Presbyterian Hospital, Philadelphia. 






rfi^o 



PHILADELPHIA: 
LINDSAY & BLAKISTON, 

1879. 









Copyright. 

LINDSAY &: BLAKISTON. 

1879. 



CONTENTS. 

PART I. 
gittalomg anir ^^gsiologg of i^e ®ar. 



CHAPTER I. 

PAGE 

The Structure of the Ear 9 

The External Ear . . . . . .13 

The Middle Ear 21 

The Internal Ear 33 



CHAPTER II. 

Physics and Physiology of Sound and Hearing. 41 
Physics and Physiology of Sound . , . .41 
Physiology of Hearing 43 

1^ V 



VI CONTENTS. 

PART 11. 

gifeoitraua of i\zxx Improper freatuuni 
CHAPTER I. 

PAGE 

Diseases of the External Ear . . . .56 

CHAPTER 11. 
Diseases of the Middle Ear . . . -77 

CHAPTER III. 

Diseases of the Internal Ear, including Deaf- 
Dumbness 102 



PART IIL 
(§txizxvi\ pggieite of llj-e ®ar. 

CHAPTER I. 

The Care of the Ear in Health . . .114 

CHAPTER n. 

The Care of the Ear in Disease, including 
the Relief of Partial Deafness and the 
Education of Partially Deaf Children and 
Deaf-Mutes 131 



Diagram of the entire Auditory Apparatus of Man ; 
Dimensions nearly natural. 




The front part of the Auditory Canal, the front half of the Drum-Head, 
and part of the Eustachian Tube are supposed to be removed. 

I. The side of the temple-bone cut through. 2. Outer surface of temple. 
3. Upper wall of bony part of hearing canal. 4. Ligament holding ham- 
mer-bone to roof of drum-cavity. 5. Roof and upper part of drum-cav- 
ity. 6. Semicircular canals. 7. Anvil bone. 8. Hammer-bone. 9. Stir- 
rup-bone. 10. Cochlea, or "snail-shell." 11. Drum-head cut across, 
and looked at sideways. 12. Isthmus of Eustachian tube. 13. Mouth 
of Eustachian tube, in the throat. 14. The hearing, or auditory, canal. 
15. Lower wall of bony canal of hearing. 16. Lower wall of cartilaginous 
part of canal, at its junction with the bony part. 17. Wax-glands. 18. 
Lobule. 19. Upper wall of cartilaginous part of hearing canal. 20. The 
mouth of the auditory canal. 21. The anti-tragus. 

viii 



HEARING, 

AND 

HOW TO KEEP IT. 



PART I. 
Anatomy and Physiology of the Ear. 



CHAPTER I. 

STRUCTURE OF THE EAR. 

THE ear is the most complicated organ of special 
sense. Its most important parts lie deeply hidden 
in the hardest bone in the body, the petrous bone, 
and on this account its complex nature is rendered 
all the more difficult to study. The external ear, /. e, 
the auricle, or ear of common language, and the audi- 
tory canal which leads to the drum-head, the drum- 
head itself, and parts of the drum-cavity or tympanum 
are visible from without, and easily accessible in the 
living ; but all other parts of the ear are not naturally 
visible. Furthermore, the dimensions of the various 

9 



lO HEARING, AND HOW TO KEEP IT. 

parts of the organ of hearing, excepting the outside 
appendage, the auricle, are very small, and in the case 
of the inner ear, where the nerve of hearing is spread 
out, they are microscopic. At the outset, therefore, 
the anatomical knowledge requisite to understanding 
the functions of the ear is hard to get. Although 
it is proposed in this little book to speak chiefly of 
the function of the ear and how to preserve it, and 
also to show what should not be done in many cases 
of injury and disease of the ear, nevertheless, the en- 
tire subject will be more clearly understood, and it is 
hoped, more profitable, if the anatomy and some of 
the more important diseases of the ear are alluded to. 
Hence, at the beginning, we shall briefly sketch the 
anatomy and physiology of the entire hearing appa- 
ratus in man. 

The exter7ial ear comprises the auricle, that part 
usually called the ear, the auditory canal, and the 
membrana tympani, or drum-head. The drum-head 
is really the partition between the external ear and 
the middle ear or drum-cavity, and partakes in the 
structures of each of these portions of the ear, as will 
be shown further on. 

The middle ear, or drum proper — the tympanum 
— lies, as its name would indicate, between the ex- 
ternal ear and the internal ear, or labyrinth. 

For the present, it will be sufficient to bear in mind 
that the middle ear is an air-cavity, and hence a 



STRUCTURE OF THE EAR. II 

characteristic of warm-blooded animals, or of those 
whg live on land. It comprises the Eustachian tube, 
which connects it with the upper back part of the 
throat, and the mastoid portion of the temporal bone, 
parts yet to be more minutely described. The middle 
ear contains the smallest bones in the human body, 
the so-called auditory ossicles, viz., the hammer, the 
anvil, and the stirrup, thus named simply from their 
resemblance in shape to these implements. 

Through this important cavity, the middle ear, pass 
two nerves, one, the facial, on its way to the face, and 
the other, really a branch of the facial, the so-called 
cord of the drum (the chorda tympani), on its way 
to the tongue. A closer analysis of this cavity will be 
given, when its anatomy claims our special attention. 

The internal ear is often called the labyrinth, on 
account of its perplexing structure and the obscurity 
which has hung about its composition and function, 
and which still hangs about some parts of it, so that 
it still deserves its name. It comprises the vestibule, 
an anterior part, as implied in its name, and the 
cochlea, or snail-shell, lying in front of the vestibule, 
the semicircular canals which lie behind it, and the 
auditory nerve, or nerve of hearing, lying beyond, 
between it and the brain, which sends nerve -branches 
to it. 

This short statement will serve as a definition of 
the three grand divisions of the organ of hearing. 



12 



HEARING, AND HOW TO KEEP IT. 



It must be borne in mind that all these parts of the 
ear lie very near the brain, in the temporal or petrous 
bone, and hence their ailments are readily communi- 
cated to the central organ of the nervous system. 
The petrous bone, the hardest, most rock-like bone 



Fig. I.— The Auricle. 




1, The pit of the anti-helix; 2, 6, 10, The so-called helix, the curved edge 
of the auricle; 3, The meatus, or mouth of the auditor^^ canal; 4, The 
tragus ; 5, The lobule ; 7, The anti-helix ; 8, The concha ; 9, The anti- 
tragus. 

in the frame, demands consideration, not only be- 
cause it contains the ear, but also because it is an 
important key in the architecture of the skull, being 



STRUCTURE OF THE EAR. 1 3 

part of the base and side of the skull, and hence help- 
ing in the protection of the brain. 

The External Ear. — The auricle, or ear of common 
language, is a shell of cartilage, covered with skin, 
closely fitting every groove and ridge of the under- 
lying cartilaginous frame, excepting at its lowest 
pendant part. Here the skin is reflected over a 
cushion of delicate fat, making the lobule, that part 
to which ear-rings are usually fastened. In some 
cases the cartilage of the auricle dips into this cush- 
ion of fat, and when the lobule is pierced, prepara- 
tory to wearing ornaments, the cartilage is wounded, 
and a very painful inflammation is set up. The auricle 
is well supplied with blood-vessels, nerves, and lym- 
phatics, being firmly held in place to the side of the 
head by ligaments, which, however, permit of a certain 
degree of passive mobility in man. The auricle grad- 
ually passes into the auditory canal, very much as 
the mouth of a trumpet fades into the tube of the 
instrument. The skin of the auricle, which is really 
part of the skin of the face, is extended into the ex- 
ternal auditory canal, the next inner-lying part of 
the ear, and continues down this passage to and over 
the drum-head ; though, of course, in the latter 
structure, it becomes extremely web-like and trans- 
parent. 

The auricle is abundantly supplied with the little 
glands characteristic of the skin, viz., the sebaceous 



14 HEARING, AND HOW TO KEEP IT. 

and the sweat glands. The former secrete a natural 
lubricator for the skin, but are not of much impor- 
tance, in this respect, in the auricle. They are most 
numerous in that part of the auricle called the concha, 
its deepest part, just at the entrance to the auditory 
canal (Frontispiece, 17). The entire surface of the 
auricle is covered with downy hairs, which, however, 
attain a very luxuriant and stiff growth at that part 
called the tragus, or goat (Fig. L, 4). This, doubtless, 
like the beard, is a protection. 

The sweat glands of the auricle are most numerous 
on the hinder surface, an important consideration in 
the management of the ears of infants, for, if their 
auricles are pressed constantly against the head, as is 
too likely to be the case, softening and chafing of 
these parts must be inevitable. 

The auricle is therefore a highly organized part of 
the hearing apparatus, as well as of the face and head. 

Physiogno77iy, — The artist studies the auricle with 
the contours of the head and face. Praxiteles, by mak- 
ing the top of the auricle pointed instead of curved, in 
a celebrated statue, has handed down through the ages 
a sculpture we call his Faun. In modern literature, 
a hint at a similar form has been wonderfully utilized 
by the genius of Hawthorne, in the weird character 
of Donatello. In so far as the Faun of Praxiteles 
or the Donatello of Hawthorne were inhuman, the 
shape of the auricle alone has been employed to 



STRUCTURE OF THE EAR. 1 5 

demonstrate it in the former, and to imply it, and to 
excuse crime in the latter. A popular feeling is, that 
a small and well-shaped ear in man is not only a 
beauty, but a sign of good breeding ; while, on the 
other hand, a large, prominent auricle is a sign of 
vulgarity. Giotto, in his drawing of Envy, in the 
chapel of the Arena, at Padua, represents the auricle 
as superhuman in size. The position of the auricle 
may be a national peculiarity, as in the Egyptians, in 
whom the auricles are placed high in the head. Con- 
siderable interest has been aroused respecting the 
meaning of a little point or prominent fold very 
often found at the upper posterior edge of the auricle 
in man. Both artist and anatomist have been at- 
tracted to these prominences, which have been found in 
the ears not only of men, but of monkeys. Advocates 
of the theory of the descent of man from the monkey, 
thought they had found in this little blunt point on 
the auricle another reason for their belief; but these 
defects in the auricle have been shown by Ludwig 
Mayer, of Germany, to be the results of inflammation 
before birth, and therefore they are congenital. They 
are in fact remnants of the edge of the cartilage of 
the auricle, the greater portion of which has been 
eroded by disease, as above stated. 

The Auditory Canal, — The auditory canal may be 
said to be a continuation inward of the trumpet, of 
which the auricle is the broad and flaring mouth 



1 6 HEARING, AND HOW TO KEEP IT, 

(Frontispiece, 14). The auditory canal is a passage 
one inch and a quarter long, averaging one- quarter of 
an inch in diameter, slightly narrower at its central 
part than at either end. It is composed one-third of 
cartilage and two-thirds of bone, and is lined through- 
out with skin, a continuation of that of the auricle, 
already considered. A general idea of its nature can 
be gained by consulting the Frontispiece. It is closed 
hermetically at its inner end by the drum-head, or 
membrana tympani. The skin of the auditory canal, 
besides the usual elements of skin, viz., sebaceous, 
perspiratory, and hair glands, contains at its outer 
part, around its entire calibre, the ceruminous, or ear- 
wax glands. These are between one and two thou- 
sand in number, and resemble in their structure 
the sweat-glands ; they are indeed what the anatomist 
calls modified sweat-glands. Their function is to 
secrete the wax of the ear, with which all are famil- 
iar. This substance is of the highest importance to 
the comfort and health of the auditory canal. So 
long as the outer end of the canal wall is smeared 
with this wax, the skin is free from itching, and the 
ear is comfortable. Its peculiarly glutinous and bit- 
ter nature is a protection against the incursion of 
insects, and it also prevents the growth of fungi, or 
mould, in the canal. 

The Drum-Head^ or the Memh'ana Tympani, — 
The drum-head, or rnembrana tympanic is that part 



STRUCTURE OF THE EAR. 



17 



of the ear forming the partition between the exter- 
nal ear and the middle ear, or drum-cavity. The 

Fig. II. — Outer Surface of the Drum- Head. Magnified 
about y/2, times. 
1 




1, The flaccid part of the drum-head ; 2, Short process ; 3, The back fold of 
the drum-head ; 4, The anvil's long and descending limb shining through 
from behind the drum-membrane ; 5, The true membrane ; 6 and 10, Inner 
end of bony canal forming frame for drum-head ; 7, The pyramid of light ; 
8, Lower part of the hammer ; 9, The front fold of the drum-head. 

drum-head is popularly called the drum ; but this is 
not a strictly correct term to apply to it. It is really 
the outer wall of the drum. The latter name is 
applicable only to the cavity of the drum or middle 
ear. 

2* B 



1 8 HEARING, AND HOW TO KEEP IT. 

The drum-head is almost circular, about a quarter 
of an inch in diameter, and o-io mm., or about ^4-^ in., 
in thickness, /. e. about as thin as fine gold-beaters' 
skin. It is composed of three distinct layers: i. An 
outer one, of skin, a continuation of that lining the 
auditory canal ; 2. A middle layer of fibrous tissue, 
the thickest of the three, and that on which the otiier 
layers are stretched ; 3. The inner layer is of mucous 
membrane, continuous with the mucous membrane 
lining the cavity of the drum. It is thus seen that 
the drum-head partakes of the structure of the exter- 
nal and of the middle ear. Running from above, 
downward and backward, in the central line of the 
drum-head, there is an opaque, white ridge. This is 
the first evidence we get by inspection of the chain 
of auditory bonelets connecting the drum-head with 
the drum-cavity, and finally with the internal ear, 
where the nerve lies. (Fig. II., 2-8.) This is the 
so-called handle of the hammer, one of the bonelets 
alluded to. This handle is firmly attached to the 
middle layer of the drum-head, and is thus all the 
more likely to move to and fro with every motion 
of the drum-head. The further advantage of this inti- 
mate connection between the hammer-handle and the 
drum-head will be shown when considering the mech- 
anism of the auditory bones as a whole. The drum- 
head is situated at the bottom of the external auditory 
canal, in a bony ring of its own, and is therefore 



STRUCTURE OF THE EAR. 1 9 

about an inch and a quarter from the mouth of the 
auditory canal at the auricle. 

When the healthy drum-head is viewed in its proper 
position, there are several features which at once at- 
tract attention. It is nearly circular in shape ; it is 
of a delicate pearl or bluish color, excepting along 
the ridge marking the position of the handle of the 
hammer-bone, where it is decidedly whiter and 
opaque. It will also at once be noticed that the 
drum-head looks like a thin membrane stretched 
over a dark, or nearly dark, cavity. Such indeed is 
the case, for the only light in the drum-cavity beyond, 
is transmitted to it through the translucent drum-head. 

The surface of the drum-head is seen to be not only 
very smooth, but polished and lustrous. So marked 
is its lustre at the lower and front part, between the 
tip of the ridge, alluded to as the handle of the ham- 
mer, and the circumference of the drum-head, that 
at this point, owing to the concavity of the mem- 
brane and its position in the axis of the auditory 
canal, a bright, cone-shaped reflection of light is 
seen running in one of the diameters of the mem- 
branes. (Fig. II., 7.) This has been called the ^'cone 
of light," and should be found in ears which have 
a drum-head of normal position and lustre. 

The handle of the hammer alluded to above, is 
more prominent at its upper part than anywhere else 
on the drum-head. This prominence has been named 



20 



HEARING, AND HOW TO KEEP IT. 



the short process, and plays a conspicuous part in the 
plotting out of the membrane by anatomists. (Fig. 
II., 2.) It looks not unlike the head of a pimple. 

Fig. III.— Inner Surface of Drum-Head of Man. Magnified 
about 3j^ times. 




, Short limb of anvil, attached to back part of outer bony wall of tympan'c 
cavity; 2, Body of anvil-bone; 3, Head of hammer-bone; 4, Neck ot 
hammer; 5 -11, Chorda tympani nerve This marks also the boundary 
line of the pockets and folds of drum-head. The latter are shown in Fig. 
2, at 9 and 3. 6, Front part of drum-membrane ; 7-8, Bony frame around 
drum-head; 9, The lower part of handle of hammer-bone; 10, Lower 
part of long limb of anvil-bone. To the point 10, the head of the stirrup 
is attached. 



STRUCTURE OF THE EAR, 21 

From it, backward and forward, to the circumference, 
pass two prominent ridges, or folds in the membrane. 
(Fig. II., 3 and 9.) These are called the folds of the 
drum-head, and serve as the upper boundary of the 
membrane proper. There is a part of the membrane 
above them, which contains no fibrous tissue, like the 
middle layer of the drum-head proper, and to this part 
the name of the flaccid membrane is given. (Fig. II., 
I.) Directly behind lies the neck and head of the 
hammer ; never visible, however, in health. 

The line of these folds is nearly the line of sup- 
port for the leverage exercised by the hammer bone- 
let. The handle is the lower arm of this lever, and 
the neck and head of the hammer, the part not visible 
from without (see Fig. III., 3 and 4), is the upper arm. 
The axial line is an important part in the function of 
the entire chain of bonelets, yet to be described. A 
general idea of the topography of the drum-head, 
as marked out by these parts just alluded to, is gained 
by consulting Figs. II. and III. 

The Middle Ear. — We have now come to the con- 
sideration of the anatomy of the middle ear, the seat 
of most of the diseases of the organ of hearing. As 
has been stated, page 11, the middle ear is composed 
of the drum-cavity and its important adjuncts — the 
Eustachian tube and the mastoid cells. Of these 
three parts, the drum-cavity is the most delicate and 
complicated in structure, and most liable to^sease. 



22 HEARING, AND HOW TO KEEP IT. 

We shall therefore give our first attention to its struc- 
ture and functions. 

Drum- Cavity. — For the sake of .convenience and 
accuracy, the drum-cavity may be said to be enclosed 
by four walls, a roof, and a floor. The four walls 
are named the front, the back, the inner, and the 
outer. Its most important contents are the three 
auditory ossicles, or the small bones of the ear. This 
cavity is about half an inch in height and width, and 
from the twelfth to the sixth of an inch deep, meas- 
uring from within outward, and lies of course just be- 
hind the drum-head. It is lined with mucous mem- 
brane, a continuation of that of the nose, throat, and 
Eustachian tube, which is reflected over the contents 
of the cavity. This is the drum proper, and the only 
part of the ear to which the term drum or tympanum 
should be applied. But great confusion constantly 
arises from applying the name ^^drum " to the drum- 
head, or the membrana tympani. 

Auditory Bonelets. — The auditory bonelets, or os- 
sicles, as they are more usually called, are three in 
number: The hammer, or malleus ; the anvil, ox incus ; 
and the stirrup, or stapes, named from their resem- 
blance in shape to these implements. They form the 
so-called '^chain of bones" of the ear. In passing 
into the drum from without, the first little bone one 
comes to is the hammer, which is the largest of the 
three. 



STRUCTURE OF THE EAR. 



23 



It is divided into a head, neck, and handle. It 

is about a quarter of an _. ___ o-u .i. t^ 

^ Fig. IV. — The three Bones of 

inch long; the handle Hearing of the right ear in their 
forms about half of this natural position, seen from with- 
length, and the head is in. Magnified about 4 times, 
about the one-eighth of 
an inch thick. Its gen- 
eral appearance and va- 
rious parts, magnified, 
about four times, may be 
learned from Fig. IV. 
It is the handle of this 
small bone which is in- 
serted into the drum- 
head, and holds, as it 
were, the latter taut. 
(Fig. II., 8, 2.) 

The hammer, besides 
this attachment to the 
drum-head, is held in position by ligaments which fasten 
it to the roof and the outer wall of the drum-cavity. 

Next in order, passing inward, comes the anvil. This 
small bone is divided into a body and two processes 
or limbs — a long and a short one. (Fig. IV., 4, 5.) 
The former is called also the descending limb, while 
the shorter one is sometimes called the horizontal 
limb. It, too, like the hammer, is held to the upper 
and posterior wall of the tympanic cavity by liga- 




:, Head of hammer ; 2, is above the long 
process and to the left of short process 
of the hammer ; 3, The handle of the 
hammer ; 4,The long limb of the anvil ; 
5, Its short limb ; 6, The stirrup. 



24 



HEARING, AND HOW TO KEEP IT. 



ments. This bone is a trifle smaller than the ham- 
mer, to which it is joined as seen in Fig. IV. This 

Fig. V. —The Bones of Hearing. Magnified 4 times. 
A B C 




Head; 



Neck ; 3, Short process ; 3-4, Handle ; 



A. Right hammer. 
5, The long process. 

B. Right ailvil. i. Body ; 2, Joint surface for union with hammer (see Fig. 
IV.) ; 3, Long process or leg. The point 3 unites with the head of the 
stirrup ; 4, Short process or leg, which is joined to the back part of the 
tympanic wall at i, Fig. III. 

C. Right stirrup, i, Head; 2 and 4, The legs; 3, The foot-plate, which 
fits into the oval window. 

joint has the peculiarity of unlocking, if the handle 
of the hammer is pulled outward ; but if the handle 
of the hammer is pushed inward, this joint is only 
more firmly locked, and the hammer carries the anvil 
with it. This will be seen to be important in the 



STRUCTURE OF THE EAR. 2^ 

mechanism of the ossicles as conductors of sound 
vibrations inward to the inrjer ear. 

The action of this joint has been likened to some 
watch-keys which wind the watch when turned in a 
certain direction, but when turned in the opposite 
way, the handle is unlocked from the barrel, and the 
watch remains unwound. 

The innermost of the three ossicles is the stirrup, 
the smallest bone in the human body, its entire length 
being one-eighth of an inch. It is divided into a 
head, a neck, two legs, and a foot-plate. The head 
is a cup-shaped button, at the junction of the two legs, 
and is designed to receive a knob-like projection on 
the end of the anvil's long limb. (Fig. V., C, i.) The 
two limbs of the stirrup are furrowed on the inner 
surface, which makes them lighter, but does not take 
from their strength. The foot-plate (Fig. IV., 6) is 
ovoid in shape, and fits accurately into the oval win- 
dow of the labyrinth, where it is hermetically held 
by a fibrous packing. Thus, the connection between 
the outer ear and the drum-head, and the labyrinth 
and the nerve of hearing, is completed. It may aid 
the understanding to liken this chain of bones to a 
bridge, v/hich thus connects the drum-head with the 
labyrinth and the auditory nerve. 

This entire bridge, or chain of bones, moves as a 
whole in and out. It is this kind of oscillation, to 
and fro, on the part of the drum-head and the chain 
3 



26 



HEARING, AND HOW TO KEEP IT. 



of the Roof. 

tween 3 and 4 times. (Helm- 

holtz. 

13 
12 




of auditory bones, that causes the foot-plate of the 
stirrup to play backward and forward with minutest 
Fig. VI. -View of the Left excursions, and it is this 
Tympanum,or Drum-Cavity, movement of the foot- 
from above, after removal plate that sets the water 
Magnified be- ^^ ^^^^ labyrinth into vi- 
brations, which in turn 
impress the auditory 
nerve, and produce hear- 
ing. 

Boundaries of the Drum. 
— The roof of the drum- 
cavity is the boundary 
between the brain and 
the drum. This partition 

nerve, marking also the boundary of jg y^j-y );\-{iXi^ SOmCtimCS it 

the so-called pouches of the drum ; 

3, Front ligament of the hammer; 4, haS chiuks iu it; hcUCe 

Supporting spine of bone ; 4-5, Ex- ^iscaSC of thc drum- 

ternal ligament of support of the 

hammer; 7, Attachment of the short cavity is liable tO paSS 

limb of the anvil to the drum-cavity; jnto the braiu and prove 

8, Ligament of support for latter; 9, 

Body of anvil-bone ; 10, The stirrup iat3-i. 

muscle ; 11, The head of the stirrup- L^j- ^\^^ rCadcr UOW im- 

restof bone invisible from this point; 

12, Joint between anvil and ham- aginc a right drum-cavity 

mer; 13, Head of hammer; 14, The opeUcd bcfore him, by 
stretcher muscle of the drum, run- i r • c 

ning from the Eustachian tube across ^^^ rCmOVal of itS rOOf. 
the drum-cavity to the hammer. ^\^^ aUtCrior Or frOUt 

wall, /. e, the wall nearest the throat, is chiefly re- 
markable for the orifice connecting it with the Eusta- 



1, Entrance to Eustachian tube and the 
throat; 2 and 6, The chorda tympani 



STRUCTURE OF THE EAR. 2/ 

chian tube (Fig. VI. i), called the tympanic, or drum- 
mouth of the Eustachian tube. There is also on its 
upper and inner part a little pyramidal elevation (Fig. 
VI. 14), through which plays the thread-like tendon 
of the muscle called the tensor tympani, the stretcher 
of the drum. This muscle is a delicate offshoot 
from the muscles of the palate, which work the Eu- 
stachian tube. 

When these muscles, in passing up from the palate, 
have nearly reached the bony portion of the tube, /. e, 
the beginning of the tympanic cavity, they stop, but 
send on to the drum-cavity a small and slender muscle. 
This muscle, a little over an inch long, lies in a nar- 
row bony canal of its own, on the upper part of the 
bony portion of the Eustachian tube, until it reaches 
the drum-cavity. Here the tympanic end of this deli- 
cate bony canal is narrowed and extended free into the 
cavity of the drum, forming the aforesaid pyramidal 
elevation. Through this, as a fulcrum, the tendon of 
the '^stretcher of the drum " {tensor tympani) passes, 
nearly at a right angle, to the drum-head, where it is 
inserted into the back part of the neck of the hammer 
bonelet. (Fig. III., near line 5.) It can now be un- 
derstood how any contraction in the delicate muscle 
just named, can be communicated to the hammer- 
bone, and by it to the drum-head. 

The back wall, like the front, is narrow. In its 
upper part is the opening which connects the drum- 



28 



HEARING, AND HOW TO KEEP IT. 



Fig. VII. — View of Inner Surface of Temporal Bone, and of 
the Inner Surface of Drum-Head, also of the Eustachian 
Tube and Mastoid Cells in Section. Natural Size. (Politzer.) 




I, 2, and 14, Inner surface of the temple ; 3, Head cf hammer-bone ; 4, The 
tensor tympani, or stretcher-muscle of the drum ; 5, Mouth of Eustachian 
tube, in throat; 6, The narrow isthmus of the tube, and, 7, its opening 
into the drum-cavity ; 8, Drum-head ; 9, 10, Mastoid cells ; 11, Handle of 
hammer ; 12, Anvil-bone ; 13, Short limb of latter, attached to outer bony 
wall of drum-cavity. This also marks entrance to mastoid cells, 9, 10. 



STRUCTURE OF THE EAR, 29 

cavity with the mastoid cells. (Fig. VI., 8, also Fig. 
VII., 13.) 

It is thus shown how the drum-cavity communicates, 
in front, with the Eustachian tube and throat, and 
behind with the mastoid cells, and it can also be seen 
that air conveyed by the Eustachian tube to the drum- 
cavity is also conveyed to the mastoid cells. 

Wider and more intricate in their topography are 
the outer and inner tympanic walls. 

The outer wall of the drum-cavity is composed 
mainly of the drum-head. The bony ring in which 
the drum-head is stretched, forms the limit of the 
outer wall. In close connection with this wall, /. e. 
the drum-head, is the handle of the hammer and the 
chorda tympani nerve. (Fig. III., 9 and 5.) There are 
also on the upper and inner part of this outer wall 
certain folds of the mucous membrane, around the 
chorda tympani nerve, called the pouches of the 
drum-head. That fold in front of the hammer, be- 
tween it and the circumference of the drum-head, is 
called the anterior pouch, (Fig. II., 9;) the fold be- 
hind the hammer is the posterior fold or pouch, and 
is the larger of the two. (Fig. II., 3.) 

The inner v^2^\. demands close examination in order 
to understand its divisions. On this wall is a convex- 
ity, called the promontory, which is caused by the 
outward projection of the lower turn of the cochlea, 
yet to be described. (Fig. VIII., 5.) This eminenqe 
3"'" 



30 



HEARING, AND HOW TO KEEP IT. 



is usually seen through the drum-head, as a pale- 
yellowish spot. Here the inner and outer walls are 

Fig. VIII. -Inner Wall of Drum- ^^^'^'^ . ^^g^^her, 
Cavity: left side. Magnified twice. ^^^ ^^ ^^"^^^ ^^^^^"^ 
(Henle.) tdich Other. Just 

above the promon- 
tory is the oval win- 
dow, (Fig. VIII., 
4,) which receives 
the foot ' plate of 
the stirrup, and 
behind and below 
the promontory is 
the round window. 
From the head of 
the stirrup runs 
the stirrup-muscle. 




, Facial nerve entering its canal; 2, Tendon 
of stretcher of the drum cut across ; 3, Eu- 
stachian tube; 4, The stirrup-bone; 5, The 
promontory; 6, The stirrup-musde; 7, The (Fig. VIII., 6.) 
canal in which the facial nerve runs, 



The long diam- 
eter of the little oval window is 3 mm., or about | 
of an inch, and its short diameter about -^q of an 
inch. The diameter of the still smaller round win- 
dow is a trifle more than y'g of an inch. A ridge 
begins above the oval window, and curves backward 
and downward, behind the promontory and the round 
window. This ridge is not only the hindmost boun- 
dary of the inner wall of the tympanum, but marks 
the course of the canal conveying the facial nerve 
through the drum-cavity to the face. (Fig. VIII., 7.) 



STRUCTURE OF THE EAR. 3 1 

It is thus seen how inflammations of the ear may ex- 
tend to this nerve, and produce, as they often do, 
paralysis of the face. 

Th^ floor oi the tympanic cavity is merely a groove, 
where the inner and outer walls of the drum-cavity 
come together. 

We have thus sketched the anatomy of the tym- 
panum or drum-cavity, the most important part of 
the middle ear. It will now be necessary to briefly 
give the prominent features of the anatomy of the 
Eustachian tube and of the mastoid cells, which form 
the remaining parts of the middle ear. 

Eustachian Tube. — The Eustachian tube is the only 
normal aerial communication between the throat and 
the drum-cavity. It opens into the upper and 
back part of the throat, or that part of the latter 
called \k\^ pharynx (J. e. the part above the palate), 
a little above the floor of the nostrils. It passes 
upward, outward, and backward to the cavity of the 
drum, forming an angle of 40° with the horizon, and 
an angle of 135° with the external auditory canal. 
The mouth of this tube in the pharynx is wide, but 
from this point the tube narrows rapidly to what is 
called the zsth?nus, from which it widens again to 
form the tympanic mouth. (Frontispiece, 11, 12, 
13.) The entire length of the Eustachian tube is a 
little more than one inch. The mouth of it, in the 
pharynx, is about |- of an inch high and -^-^ of an 
inch in width, the isthmus is ^q of an inch in width, 



32 HEARING, AND HOW TO KEEP IT. 

and the tympanic mouth is -^ of an inch in height, 
Fig. IX.— Transverse ^^^^ ^bout -.^ of an inch wide. 
Section through the About | of the tube is cartila- 
Eustachian Tube, ginous, the other third being of 
Magnified about 3 bone. (Fig. VIL, 6-7.) Across 
,4 ^" ^ section of the bony portion would 

be circular in outline, while a 
cross section of the cartilaginous 
portion would resemble a shep- 
herd's crook. (Fig. IX., 1-4.) 
This crook-shaped wall of car- 
3 — -^^ j|^^^\^ tilage is really the posterior and 
upper wall of the tube, the an- 
fe^^^ terior and lower wall or side 

2^ mpj^^^^ '^J^^^^ ^^ ^^^ ^^^^ being composed of 
Cartilaginous upper and ^ mcmbranous tissuc to which 
back wall; 2, The cavity musclcs are fastcucd. It is the 

of the tube proper; 3, The . /- i i ^ - ^ 

front wall composed of action of thcSC mUSclcS whlch 

muscle; 4, The hook- opcns the tubc, by drawing the 

shaped part of the upper f^.^^^ ^^jj ^^^^ ^j^^ ^^^j^ 

wall, curving forward to -^ 

join with the muscular wall. It is also obscrved, by 

wall. This hook-shaped ^Qj^g^l^i p- JX that the 

part moves with the mus- ° 

cies with every act of Calibre of this tube is a linear 
swallowing, and aids in ^j^^^ ^^-^^ ^q^ circular, as in the 

widening the cavity, 2, . . 

through which air passes bouy portion. It IS au offshoot 

to the inside of the drum, ^f \\^q^q mUSClcS which formS 

the Stretcher-muscle of the drum (tensor tympani), 
alluded to on p. 27. 




STRUCTURE OF THE EAR. 33 

Mastoid Cells, — The remaining division of the 
middle ear claiming our notice, is the mastoid por- 
tion of the temporal bone containing the mastoid 
cells. 

Behind the ear, as any one can feel on himself, is 
a rounded prominence. This is the mastoid portion 
now to be considered, and its interior arrangement 
may be seen by referring to Fig. VII., 9, 10, and 13. 
It communicates with the drum-cavity, as already 
stated (p. 27), which arrangement may be better un- 
derstood by referring to Fig. VII. The cavity of 
the mastoid bone is filled with a set of spongy bone- 
cells, all lined with the same mucous membrane, 
lining the drum-cavity^ which, of coursej renders them 
liable to partake in the diseases of the cavity of the 
drum. Thus the mastoid cells are seen to be in in- 
timate relation with the cavity of the drum, being in 
direct anatomical and aerial communication. 

The Internal Ear.— By the internal ear is meant 
the labyrinth and those portions of the auditory 
nerve directly connected with \\. 

The labyrinth is compdsfed of the vestibule, the 
central portion or chamber, the cochlea or snail-shell 
in front, and the semicircular canals behind. It is 
a hollow, bony cavity, the general shape of which 
may be seen in Fig. X. Allusion has already been 
made to the oval window in the inner wall of the 

C 



54 



HEARING, AND HOW TO KEEP IT. 



drum-cavity, into which fits the foot-plate of the stir- 
rup-bone. This window opens into the vestibule, 
and may be looked upon as the chief connection be- 
tween the drum-cavity 
Fig. X.— The Bony Shell of the and the labyrinth. 
Right Labyrinth. Magnified 2;^ -p- ^ ^ n ^j^^ 

vestibule must be re- 
garded as the central 
portion of the laby- 
rinth, for from it, in 
front, passes the coiled 
ly tube called the coch- 
lea (Fig. X., 7), and 

, — ^^^^^ the three peculiar 

4= 5' 6 .... 

t, So-called ampiillar end of the superior tUDCS, SCmiCirCUlar IH 

semicircular canal ; 2, Horizontal semi- shape, arC COnUCCtcd 

circular canal ; 3, Junction of superior . , . -i 1 . j .-r«. 

and posterior semicircular canals; 4, The ^ith it behind. (Fig. 

posterior semicircular canal : 5, Round X., I, 2, '?, aild 4.^ 

window; 6, Oval window; 7, Cochlea, or r^y - ^ ^i 

_ ., , 1, ihe cavity of the ves- 

snail-shell, -^ 

tibule is egg-shaped, 
or slightly pear-shaped, its dimensions being about ^ 
of an inch from within outward, and a little more than 
-fQ of an inch measured from front to back. Its four 
walls tend to unite in front, at the part of the pear- 
shaped cavity, where the cochlea begins. This latter 
part of the labyrinth may be described as a bony 
canal twisted two and a half times about a bony pil- 
lar. (Fig. XL) This canal is partially divided into 




Fig. XI. - Cochlea laid open. Magni- 
fied 4 times. (RUdinger.) 

4 



STRUCTURE OF THE EAR. 35 

two smaller canals by a bony shelf running through- 
out its entire length. (Fig. XL, i, 3, 4, 5, and 6.) 
This partition is completed by a membrane. (See Fig. 
XIIL, 8-s.) 

The canal of the 
cochlea is divided 
thus into two pas- 
sages or stairways. 
If one could pass 
by means of the 
upper one from 
the vestibule, he 
would emerge at 
last, by the lower 
one, at the drum- 
cavity, through the 

round window, i, 3, 4, S, 6, Bony shelf forming part of the par- 
tition between the two passageways of the 
1 lie latter is ClOSeO cochlear canal; 4, Represents also the hook- 
bv a membrane. ^^^^ ^'^^ of this spiral shelf as it winds around 

_ .J the bony pillar, 2 ; 7, Point of entrance of the 
Wnen tne nuia auditory nerve into the cochlea. 

in the vestibule 

and labyrinth is compressed by the pressure inward 

of the foot-plate of the stirrup, the labyrinth-liquid 

finds a point of relief at the round window in the 

slight giving in the membrane which then takes 

place. 

The semicircular cafiais are three in number, and 
communicate with the back part of the vestibule by 




36 HEARING, AND HOW TO KEEP IT. 

means oi Jive openings. We would naturally expect 
six openings for three semicircular tubes, but two of 
them, the upper and the hinder one, unite in a com- 
mon tube (Fig. X., 3) just before they reach the wall 

^' VTT ^u T3 o ui of the vestibule. This 
Fig. XII. — The Bony Cochlea 

laid open, showing the Soft completes the brief sketch 
Parts within. Magnified of the bony shell of the 
about 2^ times. (Modified labyrinth. The latter is 
from Hagen.) ^ hoUow, and in its perfect 

condition is filled with 
water, in which float soft 
parts, yet to be described, 
resembling in outline and 
shape the general shape 
of the bony box in which 
they are placed. They 

I, Ampullar enlargement on superior , . i 
semicircular canal; 2. Vestibular ^^^7 ^^ termed mem- 
nerve-branches going to 8, the ellip- braUOUS, holloW CEStS of 
tic sac, and the ampullar enlarge- ^.v _ 1 u '^i.\ ±a 

, ^ J ^ 1. the labyrmth — they are 

ments at i and 10; 3 and 6, Bony •' -' 

shelf of the cochlea on which lies termed in auatomy the 

the fringe-like nerve filaments; 4 membraUOUS labyrinth — 
and 5, ihe basilar membrane on ^ •' 

which lies the organ of Corti ; 7, and coutaiu in their soft 

The round sac; 9, The ampulla of ^^^^ delicatC CaviticS tllC 

the posterior semicircular canal. 

Still more delicate nerve- 
branches supplied to the internal ear by the auditory 
nerve. The latter, as it nears the labyrinth, on the 
inner wall of the vestibule, passes through a sieve-like 
spot into the labyrinth, and is divided into two great 




10 



STRUCTURE OF THE EAR. 



37 



Fig. XIII. — Section of 
Cochlear Canal in Pro- 
file. Magnified 20 times. 
(Modified from Hagen.) 



branches, viz., the cochlear branch and the vestibular 
branch. 

Afei7ibranous Labyrinth . — 
Respecting the soft parts of 
the labyrinth, it may be said, 
in brief, that in the vestibule 
are found two little sacs, the 
round and the elliptic. (Fig. 
XII., 7 and 8.) The latter 
is the larger; and with it 
unite the membranous semi- 
circular canals. It is joined 
to the round sac by means of 
a V-shaped tube. The round 
sac unites with the cochlea. 
Thus it is seen that the mem- 
branous labyrinth, like the 
bony case containing it, is, 
in reality, one cavity. It 
not only floats in water, but 
is filled with water. This 
labyrinth-fluid is part of the 
natural water of the brain and 
skull-cavity. 

The vestibular nerve sup- 
plies all the soft parts in the 
vestibule and membranous 
semicircular canals (Fig. 




I, The nerve of hearing; 2, The 
bony shelf through which the 
nerve passes on its way to 
Corti's organ ; A, Vestibular 
stairway, in its natural con- 
dition, filled with water. 
Through this, impressions 
pass from the vestibule to the 
organ of Corti, 8, 7, and 6; 
B, The cochlear duct, also 
filled with water, in which the 
organ of Corti lies ; C, The 
tympanic stairway, ending at 
round window; 3, The mem- 
brane of Reissner; 4, Corti's 
membrane ; 5, Attachment of 
basilar membrane to outer wall 
of cochlea ; 7, Blood-vessel cut 
across. 



38 HEARING, AND HOW TO KEEP IT. 

XII., 2), and the cochlear nerve supplies the cochlea. 
(Enters at 7, in Fig. XL) It would be of great inter- 
est to the reader to have the nerve briefly traced in 
its distribution to the cochlea. 

Cochlear Nerve and Corti' s Organ. — The cochlear 
nerve, after pushing its way into the bony pillar 
around which the cochlear canal is twisted, divides 
into a number of branches, which, emerging finally 
on the bony shelf of the cochlea (Fig. XI., 1, 3, 4, 5, 
and 6), are spread out on it in a fringe-like manner. 
In order to understand this, we shall simply trace one 
filament or nerve-thread on its way from the sieve- 
like spot, p. 36, through this bony pillar to the organ of 
Corti — its final destination. (Fig. XIII., i, 2, 6, 7, 
and 8.) The organ of Corti may be called a sup- 
porting frame-work, consisting of two pillars placed 
on the membranous partition between the two pass- 
age-ways in the cochlea. (Fig. XIV., 8 and 9.) 
They lean towards each other and are united above, 
thus forming what is known as Corti' s arch. This 
arch holds up a delicate net-work, in the meshes of 
which is fastened, both inside and outside of the arch, 
a series of cells, with fine hairs on their upper ends. 
To these cells the nerve-threads finally pass and are 
attached. (Fig. XIV., 7, 8, and 10.) Up through 
the bony pillar, out through the bony shelf to near 
its free lip, through this to the arch of Corti, from 



STRUCTURE OF THE EAR. 



39 



one side of this to the other, beyond it to the hair 
cells and into the latter, pass the nerve-threads. 

Fig. XIV.— Diagramatic Representation of Corti's Or^an, 
viewed in Profile. Magnified between 300 and 400 times, 

(Modified and reduced fioQi Hagen.) 

J3 12 11 lu 9 8 7 




1 2 3 4 5 6 

I, The base of the inner-haired cells : auditory nerve passing between 
them: 2, Section of blood-vessel; 3 and 5, The basilar membrane, 
which unites the edge of the bony shelf at i, with the outer wall of the 
cochlea at 6, thus dividing the cochlear canal into A, The vestibular spala 
or stairway, and C, The tympanic stairway; B, Represents the so-palled 
cochlear duct, separated from A by a membrane B, named after Reissner, 
its discoverer; 8, The outer pillar of Corti, leaning against 9, the inner 
pillar, forming Corti's arch; 4, Outer-haired cells, receiving nerve-fila- 
ments from 14, the nerve of hearing; 7, Upper ends of haired cells where 
the acoustic hairs are found; 10, Upper ends of inner-haired cells; 11, 
Corti's membrane; 12, Upper lip of bony shelf. The nerve of hearing, 
14, runs through lower part of shelf, and comes out at the lower lip at i. 
Corti's organ may be said to lie between the lines 5 and 12. 

There are about three thousand of these organs or 
arches of Corti in the human ear, each one of which. 



40 HEARING, AND HOW TO KEEP IT, 

it is with good reason supposed, is specially tuned 
so as to respond to the various sounds in the musical 
scale. 

Those impressions which we call sound, and which 
this delicate structure is intended to receive, will call 
for a short consideration in the next chapter, in which 
place, also, there will be given some account of the 
more general functions of various parts of the organ 
of hearing. 



CHAPTER II. 

PHYSICS AND PHYSIOLOGY OF SOUND AND HEARING. 



Physics and Physiology of Sound. 

SOUND is motion imparted to the auditory nerve. 
This motion is usually conveyed by undulations 
in the air. A shock from a sounding body, com- 
municated to the atmosphere around it, passes by a 
wave of undulation away from it, on all sides which 
are free, as the waves ripple the surface of a pool 
after a pebble has been thrown in. • Sound moves at 
the rate of 1090 ft. per second, in air, at the freezing 
point. The velocity increases two ft. a second for 
each increase of 2° C. in the temperature. The 
water must represent the atmosphere, the pebble the 
source of sound in the vibrating body, the ripples on 
the surface of the pond the sound-waves in the air, 
and the shore of the pool, the ear or the receptive 
point of the sound-waves. The perception by the 
ear of this movement in the air, /. e. of these vibra- 
tions, as they are called, is hearing. 

4* 41 



42 HEARING, AND HOW TO KEEP IT, 

Intensity of sound depends on the breadth of these 
waves ; Pitch depends upon their number in a sec- 
ond, and Quality^ clang-tint, or timbre, depends upon 
the peculiarity and the manner of the occurrence of 
the sound. Every sound is composed of a number 
of subordinate or partial tones, as they are called, 
just as ordinary light is composed of several colors. 
It is the number and strength of these partial tones 
that makes the difference in sounds. It is in these 
that one voice differs from another. The first partial 
tone is the fundamental note ; the others are the 
''over-tones,'" or the harmonics. 

Ordinary musical tones, as notes on the piano and 
organ, vary from -^Ti vibrations to 3960 vibrations, 
/. e, rapid motions backward and forward, in a sec- 
ond. Some pianos are made so as to give out notes 
with as many as 4224 vibrations in a second. The 
piccolo, a kind of flute, emits a shrill note of 4752 
vibrations a second. These are the ordinary notes 
used in music ; but the human ear distinguishes as 
music a note with as i^^^ vibrations as 20, and as 
many as 38,000 in a second. The higher notes, how- 
ever, are more or less painful to the ear, since they set 
up such powerful vibrations in the air of the auditory 
canal. 

Echo is the throwing back of sound-waves to their 
source. To recur again to the surface of the pond, 
as the waves reach the bank, it is observed that some 



PHYSfCS AND PHYSIOLOGY OF SOUND. 43 

of them appear to go back towards the point of start- 
ing, thus representing echo. 

When these sound-waves occur with regular and 
even intervals between them, we call such sound musi- 
cal. But when they occur in great irregularity, they 
produce discord or noise. 

Physiology of Hearing. — Having thus sketched 
the movements in the air we call sound-waves, let us 
follow a wave of sound from its source into the ear and 
brain, where it is interpreted as sound. Thus we 
shall learn what hearing is. 

When a wave of sound reaches the side of the head, 
part of it is taken up by the auricle, and directed 
more accurately into the external auditory canal. 
Passing down this at the rate of 1090 ft. and more 
per second, at ordinary temperatures, the wave reaches 
the drum-head, which is thrown into a to-and-fro 
motion by the wave. The drum-head imparts this 
motion to the malleus, and by it to the other ossicles, 
thus causing the entire chain to move in and out, but 
not to vibrate in the sense that a violin-string 
vibrates. They assume rather what is known as a 
pendulum-like movement or oscillation. 

By this means the little foot-plate of the stirrup- 
bone makes short in-and-out movements or excur- 
sions in the oval window. This, as we already know, 
opens into the vestibule. This movement on the part 
of the stirrup bonelet is communicated to the water 



44 HEARING, AND HOW TO KEEP IT. 

of the labyrinth. Through this fluid, the impressions 
of the sound-wave on the chain of bones is conveyed 
to the soft parts of the labyrinth, where the nerve lies; 
and it is the perception of this movement in the water 
of the labyrinth, by the nerve-threads and the brain, 
which constitutes hearing. 

Physiology of the Auricle, — In the lower mam- 
mals the auricle acts as a collector of sound. In 
them the auricle is supplied with well-developed 
muscles, and is consequently very movable, as can 
be seen by watching the horse, the cow, or the rabbit. 
In these animals the auricle is movable both forward 
and backward, so as to enable them to catch sounds 
both from before and behind, which is a characteristic 
of animals that are grass-eaters, and likely to be pur- 
sued by flesh-eating beasts. This function of the 
auricle in them is a protective one, as it enables them 
to be on the alert for their enemies. The auricle in 
the flesh-eaters, on the other hand, is by nature 
pointed forward rather than backward, and is more 
easily kept by them in that position than in any other. 
This, of course, enables them to hear their prey, which 
is, as a rule, ahead of them, and which they are in hot 
pursuit of. In aquatic mammals the auricle is very 
small, but can be drawn firmly and tightly inward, 
so as to keep out water while they swim. In man, 
however, the auricle is immovable, being unnecessary 
as an adjustable collector of sound, yet not altogether 



PHYSICS AND PHYSIOLOGY OF SOUND. 45 

free from service, since, by its shallow, trumpet-mouth 
shape, it acts as a collector or strengthener of some 
of the weaker sounds which fall upon it, and without 
it would be lost to the human ear. While it has no 
part in the quantitative conveyance of sound, it has 
a decided effect on the qualitative sensation of sound, 
as perceived by the human auditory nerve. This fact 
any one can convince himself of when in the pres- 
ence of a multitude of sounds, as, for example, by 
the sea-side, near escaping steam, or in a grove with 
rustling leaves. When in such circumstances, let the 
auricle be pressed gently forward or firmly backward 
against the side of the head. In the first instance, 
the sounds about the experimenter will seem fuller 
and deeper, and hence the deaf man instinctively 
puts his hand around and behind the auricle to enable 
him to hear all sounds better. In the second instance, 
the sounds of a deeper quality will seem to vanish, or 
be quieted, while the fainter ones, or those of higher 
pitch, will become more prominent. A further dis- 
cussion or explanation of this point would involve a 
consideration of acoustics not in place here. It will 
therefore be sufficient to say that this is simply the 
result of the composite nature of such sounds as have 
been named above, and of many others too numerous 
to mention, and of the power the auricle has by na- 
ture to strengthen by resonance the component or 
'^partial " tones in any sound. 



46 HEARING, AND HOW TO KEEP IT. 

Auditory Canal. — The auditory canal represents 
the tube of the trumpet, of which the auricle is the 
mouth. Its length, with the depth of the auricle, 
makes the external ear just the proper length or 
depth to resound to the more important and ordinary 
sounds of the human voice, as we hear it in every- 
day intercourse. 

Aside from the resonant functions, the auditory 
canal has the power to expel any surplus ear-wax 
which may accumulate in it. As already shown, the 
glands which pour out this wax lie near the mouth of 
the passage. From that point, inward, it is slightly 
up-hill on the floor of the canal, because the shape 
of the canal is that of two truncated cones placed 
together at the point where their apices are cut off. 
This makes the mouth of the canal, and the inner 
end where the drum-head is stretched, the widest, while 
the middle of the canal is the narrowest part. From 
this point, therefore, the outer part of the canal 
inclines outward and the inner part inclines inward, 
or down-hill towards the drum. A ball of wax, if let 
alone, would naturally roll out of the ear, so long as 
it is in the outer end of the canal. And as it is 
formed there, it will not pass beyond the isthmus 
of the canal unless forced artificially inward. An- 
other reason why ear-wax will naturally come out 
of the ear rather than remain in it, is because the 
skin of the drum-head and the auditory canal grows 



PHYSICS AND PHYSIOLOGY OF SOUND. 47 

outward, and tends to carry dirt and wax with it, just 
as the finger-nail grows and carries with it a spot or 
blemish, until at last the ear-wax, etc, appears at the 
mouth of the canal. But this process of nature is 
constantly interfered with by useless endeavors to 
swab and cleanse the ear. 

Membrana Tympanic or Drum- Head, — The func- 
tion of the membrana tympani is to collect sound- 
waves, transmit their impulses to the chain of little ear- 
bones, and support and keep in proper position the 
malleus or hammer-bone, and by that means the 
entire chain of bones, so that they will swing easily, 
like a miniature pendulum. Another function is to 
protect the mucous membrane lining the drum from 
the effects of the air. 

A general idea of its function as a sound collector 
has been alluded to on p. 18, as well as the transmis- 
sion of the impulse of the sound-wave by the chain 
of three bonelets to the vestibule and the auditory 
nerve. 

If the membrana tympani is pressed too far either 
inward or outward, the chain of bonelets can- 
not swing properly, and hence sound cannot be 
transmitted ; because, if the drum-head is pressed 
inward, the bones are pressed upon each, and are so 
locked as not to be able to oscillate freely. If, on 
the other hand, the drum-head is forced outward, the 
malleus is carried outward, is thus partially unlocked 



48 HEARING, AND HOW TO KEEP IT, 

from the next bone, the anvil ; and the chain being 
thus broken, sounds are not transmitted. In either 
condition, the conducting apparatus is said to be out' 
of equilibrium. One of the greatest evils in a large 
perforation of the drum is the loss of outward trac- 
tion the chain of bones thus loses. That is, the 
balance of power between the drum-membrane and 
the stretcher-muscle of the drum being destroyed, 
the latter drags the chain of bones too far inward. 
They are then unduly locked on each other, and 
their swinging function altered, so that hearing is 
impaired. 

When the drum-head is perforated, the mucous 
membrane of the middle ear is directly exposed to 
the external air. To protect this is one of the great- 
est functions of the drum-membrane. So evident is 
this, that many cases of aural discharge and deaf- 
ness are relieved, and the drum-membrane aided in 
healing, by simply covering the perforation with a 
paper disk, after the suggestion of Dr. C. J. Blake, of 
Boston, or by protecting it with a little pellet of 
cotton. 

The intact drum-membrane effectually prevents the 
entrance of anything like an insect into the head. 
Hence, it is foolish to become alarmed, when a for- 
eign substance gets into the ear, with the idea that it 
may penetrate further and pass into the brain. This 
it cannot do, for the drum-head is stretched across 



PHYSICS AND PHYSIOLOGY OF SOUND. 49 

the inner end of the canal to prevent such an oc- 
currence. 

If the membrane is perforated, then a substance in 
the canal might pass into the drum-cavity, but not into 
the brain ; for that is an impossibility, as the brain 
lies inside the bony case of the skull. As we shall 
show further on, when disease of the ear eats into and 
destroys the bony partition which separates the ear- 
cavity from the brain, then the latter may become 
diseased in consequence of the original disease in the 
ear. 

Tympanic Cavity. — The chief physiological function 
of the tympanic, or drum- cavity, is to act as an air- 
chamber, over one side of which the drum-head is 
stretched. This function of the drum can be clearly 
understood by recalling the structure of the drum of 
the musician. In both cases we find a membrane 
stretched over a hollow box, to which the air must 
have free access in order to enable the membrane or 
*'head" to vibrate properly. In the musical instru- 
ment this free supply of air is kept up by a little hole 
in one side of the drum, and in the human ear-drum 
this air-supply is effected by means of the Eustachian 
tube. This conveys air to the tympanum, as will be 
shown further on. Hence, if this air-supply is taken 
away from the drum-cavity of the ear, by closure of 
the Eustachian tube, the air in the cavity soon be- 
comes absorbed, a vacuum is formed in the drum, and 
5 I^ 



§0 HEARING, AND HOW TO KEEP IT, 

the drum-head is of course forced inward by the press- 
ure of the external air. As has already been shown, 
this causes a locking of the auditory bonelets, and 
deafness ensues. (P. 47.) When considering the dis- 
eases of the ear, the bad effects of this vacuum in the 
drum will be further alluded to. 

Eustachian Tube. — Every act of swallowing draws 
the front wall of the Eustachian tube from the back 
wall, and thus opens the tube. Air, of course, then 
passes into the drum-cavity, and thus a constant and 
even pressure of air is maintained on both sides of 
the drum- head. Were this not so, the air in the 
drum would be gradually absorbed, and the air on the 
outside of the drum-head would press the latter so far 
and so firmly inward as to impede its vibrations. 
This is the case when the tube is temporarily closed 
from any cause, and it is such a closure that is a com- 
mon cause of deafness. 

In children, a sudden closure of the Eustachian 
tube, and the consequent want in proper ventilation 
of the drum-cavity, causes earache and deafness by 
the undue inward pressure thus induced in the drum- 
head. 

Every one knows that a membrane tightly stretched 
over a preserving jar will sink in if the air becomes 
exhausted from the under side. It is just the same 
state of affairs in the drum, if air is exhausted from 
the inner side of the drum-head. Hence the pain 



PHYSICS AND PHYSIOLOGY OF SOUND. 5 I 

and impeded hearing in such cases. The Eustachian 
tube acts like a safety-valve in cases where the drum- 
head is forced suddenly inward by the concussion of 
a blow or an explosion. The air behind the drum- 
head is forced into the tube, and even into the throat, 
thus allowing the drum-head to give enough to save 
it from rupture. Could it not then recoil, the re- 
sistance it would offer to the force of the blow would 
cause it to burst. 

Mastoid Cells. — The benefits of the close connec- 
tion between the drum-cavity and the mastoid cells 
(p. 29) will be best appreciated by a consideration 
of some of the facts pertaining to the physiology of 
the middle ear. It is a well-established fact in phys- 
ics, that sound-waves will produce the greatest effect 
when, in the middle ear, the following three condi- 
tions are maintained : 

1. The Eustachian tube must remain shut most of 
the time. 

2. It must, however, be opened sometimes for pur- 
poses of ventilation ; and this it is at every act of 
swallowing. 

3. The cavity of the drum — the tympanum — must 
be in communication with large, irregular air-cavities, 
and this is gained by its aforesaid connection with 
the irregular, spongy cells of the mastoid bone. 

This is a very important aid to the ear in hearing 
deep tones, for, in order that the tympanum may 



52 HEARING, AND HOW TO KEEP IT. 

properly receive the latter, it must have depth and 
capacity; therefore the tympanic cavity is in con- 
nection with the cavities of the mastoid cells. The 
beauty of this arrangement is better seen, when it is 
known that a larger drum-cavity, with regular outline 
and form, would be useless from its great resonance 
or echo. Hence, the irregular, spongy cavities of the 
mastoid bone, with which the drum is connected, ap- 
pear to be necessary to accurate hearing. 

Internal Ear. 

When we come to the consideration of the physi- 
ology of the internal ear, it must be borne in mind 
that we are considering the mechanism of a water- 
containing cavity. It is practically a bony case filled 
with water, in which float, with slight attachments, 
the membranous parts of the internal ear or laby- 
rinth. (See p. 36.) 

The general mechanism of this part of the ear may 
be understood by likening the labyrinth to a perfectly 
water-tight keg lying on its side. On the side of the 
barrel towards us, we shall find an oval hole hermet- 
ically closed by a leather patch, and on the head of 
the barrel, let us say to our right if we are examining 
the left ear, we shall find a round hole, also hermet- 
ically closed by a leather patch. At two points, then, 
in this water-containing case, we shall find spots which 



PHYSICS AND PHYSIOLOGY OF SOUND. 53 

would yield slightly to pressure, either from within or 
without, so that if one were pressed inward the other 
would give correspondingly in an outward direction. 
This is just what is found in the oval and round win- 
dows of the labyrinth. Pressure inward from the base 
of the stirrup-bone is communicated to the fluid of 
the labyrinth, which, however, would not be thrown 
into motion, were it not possible for the labyrinth 
fluid to recoil by means of the yielding of that part 
of the boundary of the labyrinth known as the mem- 
brane of the round window. 

It becomes manifest, therefore, from this arrange- 
ment, that the physiological mechanism of the inter- 
nal ear depends on certain movements in the fluid 
with which it is filled. Whether this is simply an 
in-and-out motion, or a series of undulations, is not 
known. 

Vestibule and Semicircular Canals. — It has often 
been supposed by leading physiologists that we hear 
noises with the vestibule nerves, while music is heard 
by the delicate nerve-structures in the cochlea. 

It would seem that all hearing is effected by means 
of vibratile hairs on peculiar cells in communication 
with the ends of the various nerve-branches which 
reach the internal ear. This theory is based on the 
observations of Hensen and Ranke, of Germany, 
upon certain marine animals with transparent bodies. 
Examination of these animals by the microscope re- 
5* 



54 HEARING, AND HOW TO KEEP IT, 

veals not only curious cells tufted with stiff hairs/ 
in connection with the nervous structures of their 
internal ears, which cells resemble the haired cells 
found in the internal ear of man, but it has been 
also observed that these stiff hairs vibrate, some with 
one, and some with other musical notes, when the 
latter are sounded near them. 

There is every probability, therefore, that the most 
sensitive parts of the internal ear are these stiff-haired 
cells, each one of which is probably endowed with 
power of responding to the various sounds and notes 
which fall on our ears. These cells are especially 
numerous in the cochlea, the entire arrangement of 
which seems to be to favor the support and protec- 
tion of these wonderful and minute bodies. (Fig. 
XIV., 7.) 

The physiology of the semicircular canals is not 
known. It is supposed, however, and with some 
very good reasons deduced from experiments by a 
number of eminent Germans and Frenchmen, that 
these canals are endowed. with a peculiar sensibility 
as to the position of the head and body, and that in 
them resides, so to speak, the sense of equilibrium, 
or proper carriage of the body. Hence, when these 
canals are artificially wounded or destroyed in birds 
and animals, the latter are no longer able to control 
the movements of the body when they attempt to 
fly or walk. There then ensue peculiar reeling and 



PHYSICS AND PHYSIOLOGY OF SOUND. 55 

falling symptoms, without loss of consciousness. 
Since, with certain positive signs of ear-disease in 
man, there ensue at times just such peculiar reelings 
and falls, without loss of consciousness, it is supposed 
that these canals, in such instances, are the seat of 
disease. In the present day, therefore, some physi- 
ologists speak of a sense of equilibrium, and place 
its seat in these peculiar canals in the back part of 
the labyrinth. 



PART 11. 

The Chief Diseases and Injuries of the Ear, and 
the Avoidance of their Improper Treatment. 



CHAPTER I. 

DISEASES OF THE EXTERNAL EAR. 



Diseases of the Auricle. 

THE auricle is liable to frost-bites in very cold 
weather. Although this is not dangerous either 
to the hearing or the health of the individual, it is 
painful, and, in the end, it may be disfiguring. The 
latter result is brought about either by the contrac- 
tions which ensue on healing, or by the formation of 
lumps of new cartilage or of chalk in the structure 
of the auricle. When the auricle is frost-bitten, it 
becomes very white and dead-looking. It is also 
very brittle and insensible. Great care must be 
taken not to break it, and also not to heat it too 
quickly. Gentle handling is, therefore, necessary 

56 



DISEASES OF THE EXTERNAL EAR. 57 

and heat must not be applied at all at first. A gentle 
chafing or rubbing with snow or ice will be the best 
way of restoring, slowly, the circulation of the blood 
to the frost-bitten part. If heat should be applied, 
instead of stimulating by cold or very moderately 
tepid water, sudden inflammation may set in, and the 
ear will be just as though it had been burnt instead 
of frozen. Apply cold until the skin of the frozen 
ear begins to have feeling in it once more ; then the 
organ is safe. 

A severe blow on the ear may break the cartilage 
of the auricle, or may so loosen the covering of the 
cartilage as to permit blood to get under it, and 
remain there until inflammation of a low form is set 
up, which will liberate the blood, but deform, disgust- 
ingly, an otherwise beautiful feature of the face. 
This distortion is sometimes seen in the pugilist and 
in the insane. In the latter class it may be brought 
about either by violence on the part of themselves, 
their attendants, or their companions in sorrow; or it 
may be, as is held by many high authorities, a spon- 
taneous symptom of the disease which is usually 
attended with so much debility, weakening of the 
tissues of the body, and defective circulation of the 
blood, that the latter, as it were, bursts from its limits, 
not only in the brain, but on the surface of the body. 
It is also supposed that^ this blood tumor of the ear, 
when it forms spontaneously in the auricle of the 



58 HEARING, AND HOW TO KEEP IT, 

insane, is a diversion of the blood from the brain, 
and, as such, saves the life of the lunatic for the time 
being. In this view, the disease may be said to be 
an apoplexy of the auricle occurring instead of an 
apoplexy of the brain. 

Imperfect Development. — Sometimes individuals 
are born without auricles, or they may be born with 
several auricles, some of which may be unnaturally 
placed, as, for example, low down on the neck. Again, 
the auricle may be only partially formed ; yet, with 
all these defects, the hearing may be good. The 
hearing is rarely affected in such cases, unless the de- 
fect of the auricle is found to extend to the auditory 
canal or deeper parts of the ear. There is also a rare 
inborn defect, in some cases, in which a small hole 
persists in front of the auricle, where the cheek joins 
the latter. This is called a fistula of the ear, and may 
communicate either with the throat or the cavity of 
the drum, or with both. It seems to have no effect 
on hearing, and it may heal up in after years. 

Skin Diseases. — The auricle is liable to numerous 
diseases of the skin, as chafing, sunburn, slight red- 
ness or inflammation from contact with poisonous 
plants, erysipelas, eczema, boils, syphilitic eruptions, 
shingles, and cancer. 

Although many of these demand very little treat- 
ment, or are easily cured, nevertheless none should 
be neglected, and of course the graver ones would 



DISEASES OF THE EXTERNAL EAR. 59 

instantly obtain attention. In all cases, whatever is 
put on the auricle to cure its diseases, should be care- 
fully kept from running into the ear. An application, 
simple so long as confined to the auricle, might irrep- 
arably injure the drum, if allowed to reach it, by being 
allowed to run into the auditory canal. 

Diseases of the Auditory Canal. 

Foreign Bodies. — And this brings us, first, to the 
consideration of foreign bodies in the ear. It is quite 
a common thing for children to put various objects 
into their ears, in ignorant playfulness. As a rule, 
anything which they would or could get into their 
ears can be removed ; but not easily by any member 
of the family, unless he have special skill. It may 
be said, for the comfort of friends and parents, that 
no bead, button, '^spit-ball,'* bean, grain of wheat 
or maize, or any similar small, smooth object which 
a child could put into its ear, will do any harm, if lei 
alone by all save one entirely conversant with the 
structure of the ear, and properly supplied with in- 
struments for examination and treatment. If your 
child, therefore, gets any such foreign matter in its 
ear, rest assured such object has not gone beyond 
reach of surgical skill. The harm in such cases 
usually arises from the unskilful means resorted to, in 
haste and consternation, for its removal. Let it alone 
until it can be properly removed. It can do no harm 



6o HEARING, AND HOW TO KEEP IT. 

at the outset ; it cannot reach the brain unless you push 
it there (see pp. 48, 49) ; but a careless grappling for 
a foreign object in the ear may force it still further 
inward, lacerate the auditory canal, and perforate the 
drum-head. The pain thus given to the patient is 
usually mistaken for pain caused by the presence of 
the foreign body in the ear, and only stimulates the 
ignorant manipulator to still further unskilful and 
excruciating treatment of the ear. Not only chil- 
dren, but even adults, have been subjected to this 
most injurious treatment. The writer observed, not 
long since, the case of a mechanic, thirty-five years 
old, who allowed his comrades to pick mud from his 
ear, where it had been splashed by a passing horse. 
A syringeful of warm water would have given the 
necessary relief. Instead of this, however, the man 
and his companions, uselessly frightened by the 
thought that a little mud was in his ear, began to pick 
at the ear with bits of wire and other equally unsuit- 
able instruments. This caused intense pain, which 
was construed as a symptom of the need of still fur- 
ther probing, until the man's drum and all the little 
bones of his ear were completely scooped out, and 
his hearing destroyed forever. 

On the other hand, children who have placed beans 
and beads in their ears, and have not said anything 
about their prank for fear of parental punishment, are 
living proofs of the comparative harmlessness of the 



DISEASES OF THE EXTERNAL EAR. 6 1 

presence of such things in the ear. Of course such 
things may do harm, and should always be removed 
in time, and by the proper person ; but they had bet- 
ter stay there forever, than that any one should meet 
with the experience of the mechanic narrated above. 

The writer, while removing a plug of ear-wax from 
the ear of an intelligent woman, fifty-eight years old, 
was surprised to see a solid blue glass bead roll from 
the ear during the syringing. The patient assured 
him that, fifty years previous, she had played with 
such beads, but had not seen any like this one since 
that time, nor could she remember that she had put 
any of these beads in her ear. Yet she felt convinced 
that she had done so, and had forgotten the act. 
Without doubt such had been the case, and the bead 
had remained fifty years in her ear without even her 
knowledge. Gradually wax had accumulated around 
it, and this, by causing deafness, led her to apply for 
relief, which finally led to the removal of the lost 
bead. This is quoted to show how much worse the 
usual gross endeavor at removal is, than even letting 
the foreign object alone. 

The simplest, softest, most agreeable, and usually 
the most successful way to try to remove a foreign 
body from the ear, is to gently force it out by syring- 
ing. 

This method is applicable especially to insoluble 
and inanimate objects. Too long continued use of 
6 



62 HEARING, AND HOW TO KEEP IT, 

the syringe, in cases of entrance of grains of corn or 
of beans into the ear, would soften and swell them. 
But a trial of this method should be given for a rea- 
sonable time in any case by any one who is not within 
reach of a physician. 

Insects in the Ear, — Greater and immediate annoy- 
ances are occasioned both to adults and children by 
the entrance of insects into the ear. It happens now 
and then that flies, ants, bed-bugs, fleas, small roaches, 
and the like, get into the ear. Most commonly it is 
a fly that gets into the ears of children. This will 
cause great fright and considerable pain, and some- 
times the peculiar irritation in the ear may produce 
a convulsion. It should be stated here that there is 
a branch of the pneumogastric nerve — the great 
nerve supplying the stomach and lungs — distributed 
to the auditory canal. It is therefore quite common 
to observe both vomiting and coughing as the result 
of irritation in the ear. 

Adults sleeping on the floor, usually in the summer 
time, often experience intense annoyance and pain in 
the ear from an incursion of a roach or some smaller 
variety of the beetle tribe, so constantly found at that 
season of the year. 

Here, both syringing and the use of sweet oil come 
into good service, since they will tend not only to 
smother, but to remove the offender. 

Syringing the Ear, — A few directions respecting 



DISEASES OF THE EXTERNAL EAR. 63 

this important manipulation should appear at this 
point. The first injunction is fiever use cold water 
in the syringe. A short, hard rubber syringe, such 
as is known in drug- stores as a small syringe, No. 2, 
is about the best kind for general use. This should 
move easily, without jerks. An ordinary finger-bowl 
may be employed not only to hold the warm water, 
but to catch the current as it returns from the ear. 
The patient can easily hold this vessel against his 
cheek during the syringing, unless it be an infant, 
when a large towel under the ear will catch the return 
current from the syringe. 

The syringer should take the auricle at its upper- 
back edge, between two fingers, and draw it gently 
upward and backward, so as thus to straighten the 
cartilaginous part of the auditory canal, and facilitate 
the entrance of the water. The nozzle of the syringe, 
held close to the ear, should then be directed down- 
ward and forward, so as to best convey the water to 
the depth of the canal of the ear. 

A few drops of warm sweet oil will often cause the 
insect to crawl out ; if not, it will smother it, and the 
creature will float to the surface of the fluid, and can 
then be easily removed from the ear. 

There are of course numerous diseases of the exter- 
nal auditory canal — the canal leading to the drum- 
head — which the non-professional reader could not 
understand if they were described here. 



64 HEARING, AND HOW TO KEEP IT. 

It will suffice, therefore, merely to state that boils 
and abscesses are common at this part of the ear, and 
are exceedingly painful ; but it is impossible for the 
patient to know, from his pain, whether he is suffering 
from a boil, a larger abscess, or from a wider inflam- 
mation in the auditory canal, or whether his earache 
is caused by inflammation in the drum. As a general 
rule, if the ear is sensitive to touch, the disease lies in 
the external ear, and the pain seems nearer the surface 
of the body. If the pain is deep, and at the same 
time the external ear is comparatively free from sen- 
sitiveness to touch, it may be concluded that the dis- 
ease is in the drum. But this is only a very imperfect 
guide, and must not be implicitly relied on. Rather 
let it lead to the consulting of a surgeon to clear up 
the doubts. 

Boils and FuTigi. — One of the most painful of ear- 
diseases is an attack of boils in the auditory canal, 
usually at that point where the auricle passes into the 
canal. Not uncommonly these are caused by the 
irritation in the canal set up by the growth of a mi- 
croscopic vegetable parasite, the fungus Aspergillus. 
In many cases, however, it is not easy to say whether 
the fungus excited the boil, or whether the small par- 
ticles of matter from the boil have supplied the soil 
most likely to cause this parasitic plant to grow in 
the auditory canal. Be this as it may, the presence 
of this parasite in the ear excites a stubborn and 



DISEASES OF THE EXTERNAL EAR. 65 

intense inflammation in the organ, with earache and 
deafness. The usual recourse now is to pour oil or 
fatty matters into the ear, which, unfortunately for the 
patient, only feed the fungus, cause it to grow with 
renewed vigor, and the patient grows worse. Oils 
and fats should, as a rule, be kept from the ear, and 
most positively they should never be used if this 
parasitic fungus has attacked the ear. 

After a boil in the ear, the ear should be most care- 
fully syringed, in order to clean away all remnants of 
blood and matter which might offer a harbor for this 
fungus. The microscope alone is able to decide 
whether this minute vegetable is in the ear or not. 
Sooner or later the fungus attacks the drum-head and 
inflames it, as will be shown further on. 

Usually all earache is attended with diminution 
of hearing. The only exception is neuralgic pain, 
arising from defective teeth. 

Neuralgia in the Auditory Canal, — A word must 
be given about a very painful disease, viz., neuralgia in 
the canal. This, of course, is classed with earache, 
and often falls under the domestic treatment for such 
complaints. Its cause is almost invariably decayed 
or improperly-filled teeth. A singular feature of this 
disease is, that very often the tooth which causes the 
pain in the ear is not painful itself, nor even tender 
to the touch. Of course, where toothache exists, 
and seems to dart into the ear, the patient is often 
6^ E 



66 HEARING, AND HOW TO KEEP IT, 

led, very properly, to consider the tooth as the real 
cause of the earache. There is no discharge in these 
cases, at least not at first, and there is no attendant 
deafness nor noises in the ear and head. When, 
therefore, a severe pain sets in, in the ear, without 
any other symptom in the ear, the patient should con- 
clude that his ear is neuralgic by reflection, as it may 
be termed, from the decayed or otherwise diseased 
tooth. An examination of the mouth, in such cases, 
will generally reveal at least a' hollow tooth, or a tender 
one on the same side as the aching ear. 

Too frequently, however, the neuralgia is mistaken 
for inflammation in the ear, and improper remedies 
of all kinds, hot oils, fats, various kinds of vegetable 
matters, etc., are put in. These irritate the ear, and 
finally, in addition to the neuralgia, there is an in- 
flammation with discharge from the ear. The only 
cure for neuralgia in the auditory canal or in the ear 
is the extraction of the offending tooth. 

In this instance the pain will disappear on the re- 
moval of the diseased teeth. 

Hardness of hearing is caused by the closure of the 
auditory canal by bony tumors, which in many cases, 
though not entirely blocking the calibre of the pas- 
sage, lead to the retention of wax and dead skin ; 
on this account deafness is sometimes suddenly .in- 
duced without any previous warning to the patient. 
Great care should be exercised in such cases not to 



DISEASES OF THE EXTERNAL EAR, 6/ 

wound the skin, which is very tender, over these 
bony growths in the canal. 

Sometimes cancer affects the external auditory 
canal ; but this is a rare occurrence, and will usually 
be detected by the surgeon to whom the attendant 
pain drives the patient. 

What then is the general reader to derive from 
having read the foregoing pages on the auricle and 
auditory canal — their anatomy, physiology, and dis- 
eases? Simply this, that they are highly organized 
and in many ways delicate structures; and that in 
most cases of disease, nothing had better be done than 
to resort to unskilful treatment from ignorant hands. 
When reference is made to the management of the 
ear in health, it will be shown how far this organ 
should be let alone, and that rational protection of 
the ear and the prevention of disease are very largely 
entirely within our own control. 

The Drum-Head, or the Membrana Tympani. 

Injuries and Diseases. — The drum-head, as might 
be supposed from its thinness and comparatively ex- 
posed position, is liable to injuries, producing in it 
perforation, rupture, and inflammation. A perfora- 
tion or rupture in this delicate membrane is not as 
directly injurious either to hearing or to health as is 
generally supposed. In some respects a simple per- 
foration in the drum-head is of no consequence, as it 



68 HEARING, AND HOW TO KEEP IT, 

will heal rapidly in a healthy membrane. Indeed, 
some forms of deafness are cured by a perforation in 
the drum-head. 

The first great danger in all cases of accidental 
perforation in the drum-head is, that a force produc- 
tive of such a fissure in it may, by concussion, affect 
the deeper nerve - structure of the ear. The next 
evil that may directly attend a perforation in the 
drum-head is the exposure of the delicate mucous 
membrane of the drum-cavity, which necessarily fol- 
lows such an opening in this membrane, which forms 
the outer wall of the drum-cavity. 

The most common forces which produce this injury 
in the drum-head are concussions in the form of un- 
expected explosions, and '^ boxes on the ear." 

The explosive force comes on the drum-head either 
so suddenly that the membrane is not prepared for it, 
or it is so powerful and the membrane so delicate, per- 
haps already weakened by disease, that the membrane 
is unable to resist it. If the Eustachian tube is tem- 
porarily closed, the drum-membrane would be all the 
more likely to be burst. 

These accidents are common among soldiery, spec- 
tators at military reviews, and sportsmen, and they 
have occurred by the sudden explosion of gas-bags 
used in chemical experiments.^ In order to provide 

■^ Drs. Green and Shaw, of Boston, had between them five 
cases of ruptured drum produced by an exploding gas-bag. 



DISEASES OF THE EXTERNAL EAR. 69 

against such accidents, the soldier, during heavy can- 
nonading, opens his mouth so as to allow of an equal 
tension of air on each side of his drum-head through 
the Eustachian tube. 

This also permits all the more easily, in case of a 
sudden cpncussion conveyed through the external 
auditory canal, of a recoil of the air in the drum- 
cavity through the Eustachian tube, and the drum- 
head is thus relieved of some of the force of the blow. 

Wearing cotton in the ear at such times has also 
been supposed to protect the drum-head from some 
of the force of concussion. 

The sudden explosion of gas-bags, or of many other 
accidental explosions, can hardly be guarded against 
so far as the ear is concerned. In the event of such 
an explosion, if the ear seems benumbed, it should be 
examined immediately by an expert. 

A word of caution here both to physician and pa- 
tient. In all such cases of either supposed or ascer- 
tained accidental rupture of the membrane, nothing 
should be put into the ear. The rupture in the drum 
connects the outer ear with the drum-cavity, and any 
''drops" now put into the auditory canal will pass 
directly into the drum-cavity, and there setup inflam- 
mation. In all such cases, simply protect the mouth 
of the canal with a little dry cotton, and it will be 
found that in the vast majority of cases, perhaps in all, 
the ruptured drum-head will heal, and if the nerve 



70 HEARING, AND HOW TO KEEP IT, 

of hearing has not been injured by the concussion 
which has produced the perforation in the membrane, 
the hearing will not have been injured. It is altogether 
different when the rupture of the drum-head has been 
produced by disease, and when a running from the 
ear continues. The drops will then do more good the 
further into the ear they penetrate. 

Another force productive of rupture of the drum- 
head, quite common among brutal people, is a '^box 
on the ear." This is inflicted not only upon children, 
but the writer observed an instance of such an injury 
to the drum in a man, produced by a blow over the 
ear, given in rude play. The treatment of such cases 
is the same as in the above. These instances of injury 
from a blow by the hand often come into court, and 
the plaintiff is usually regarded in too much the light 
of a greatly injured person, simply because the '^drum 
is perforated.'' 

Now, as has been said, if the nerve is not paralyzed 
by the force of the blow, the perforation of the drum- 
head, considered alone, is of minor importance. It 
has exposed the drum-cavity; but if, after such an in- 
jury, the ear has not been meddled with by the ig- 
norant, and if nothing has been put into the ear, and 
thus into the drum-cavity, the membrane will heal 
again, and therefore the affair really demands less ju- 
dicial consideration than it sometimes gets. In all 
such cases the condition of the ear before the blow, 



DISEASES OF THE EXTERNAL EAR. yi 

as well as its condition after the injury, should be 
inquired into, and it should also be found out whether 
anything was put into the ear after the perforation of 
the drum-head to heal it. If the latter has been 
done, it may be the real cause of the subsequent pain 
and deafness. 

There-is another class of injuries to the drum, pro- 
duced by the accidental entrance of a long and sharp 
instrument into the canal. Thus, while scratching 
one's ear with a pin, thin pen-holder, pencil, ear-pick, 
or any other similar object, the elbow may be jogged 
in various ways, and the pointed instrument, being 
so very near the drum-head, the latter is quickly per- 
forated. This, as a rule, causes a sharp dart of pain. 
In one instance, the writer knew of the Assuring of a 
drum-head caused by the sudden entrance of the deli- 
cate end of the rib of a lady's parasol into her ear as 
she turned quickly in a crowded street-car. It healed 
quickly,but with some permanent defect in her hearing. 

Great care should be exerted to avoid all risks of 
perforating the drum, and one way to accomplish this 
will be to most sedulously avoid a habit, entirely 
too common, of scratching the ear with pins, hair- 
pins, and ear-picks, or, in fact, with anything but 
the finger-end. 

Allusion will be made to the injurious results of 
swabbing the ear with sponges, etc. , for purposes of, 
as it is erroneously named, cleaning the organ. But 



72 HEARING, AND HOW TO KEEP IT. 

there is a class of individuals who pick and scratch 
their ears, as a kind of amusement, with any slender 
and pointed instrument which may be nearest at 
hand. They should be informed that their practice 
is not as innocent as they imagine, and that it may 
quickly lead them into considerable pain, annoyance, 
and perhaps permanent injury to the organ of hear- 
ing. 

Although, in most cases, no inflammation is aroused 
in the drum by the aforesaid accidental perforations, in 
other cases an inflammation in this important structure 
is thus set up. This, of course, is very painful, and, 
unless carefully treated, will result in adhesion be- 
tween the drum-head and the inner parts of the 
drum-cavity, which in turn produces hardness of 
hearing. 

In some cases of accidental perforation of the drum- 
head with slender instruments, the latter are forced 
into the cavity of the drum, and in some instances, 
it has been thought, even as far as the internal ear. 
Thus the hearing is destroyed by direct injury to the 
contents of the drum, and to the inner ear, where 
the nerve of hearing lies, though the drum-head may 
finally heal. 

Inflammation in the drum-head is sometimes ex- 
cited by the entrance of cold water into the external 
ear. A similar inflammation may be excited by the 
entrance of very cold air into the ear. But the for- 



DISEASES OF THE EXTERNAL EAR. 73 

mer is the cause of a number of cases of ear-disease, 
especially in boys, after their prolonged swimming in 
river or sea in summer time. Girls, too, who have- 
access to private ponds or creeks, are thus exposed to 
the evil results of too much cold-water bathing. 

In some of these cases, if the ear be examined 
shortly after the pain sets in, it will be seen that the 
drum-head is reddened, /. e. congested in its outer 
surface; in other cases it appears that congestion, and 
perhaps inflammation, has been excited in the drum- 
cavity on the inner surface of the drum-head. Some 
authorities think that this inflammation in the ear, 
coming on after bathing in cold water, is due not 
only to the entrance of cold water into the external 
ear, /. e. to direct contact with the drum-head, but 
also to the irritation set up in the Eustachian tube, 
and from it conveyed to the middle ear or drum- 
cavity. The latter irritation is caused by the almost 
inevitable strangling, and snufling in of water through 
the nostrils and Eustachian tube, which these young 
bathers, as well as older ones, are liable to. 

It may be that in both ways the evil eflects of cold 
water are conveyed to the ear; as far as the writer's 
observation is extended, it leads him to regard the 
former as the more common way. 

The Growth of Fungi on the Drum-Head. — Other 
causes of inflammation of the drum-head are the 
growth of fungi and swabbing the ear. The latter 
7 



74 HEARING, AND HOW TO KEEP IT, 

irritates by packing back upon the drum-head masses 
of wax and dead skin. The evil results of this swab- 
bing and the removal of the natural ear-wax will be 
considered under the hygiene of the ear. 

The growth of the fungus Aspergillus on the drum- 
head and the wall of the auditory canal is by no 
means uncommon. The cause of it is by no means 
neglect of the ear ; it is usually one of the results of 
too much swabbing and picking the ear. This causes 
irritation of and discharge from the. skin of the canal, 
and the fungus is thus invited to grow in the ear as 
the small amounts of discharge putrefy. The fungus 
by instinct seeks a secluded spot for growing, and is 
thus led to grow first and chiefly on the drum-head, 
which, as the reader now knows, forms the bottom 
of the auditory canal. 

The attack thus made by the fungus on the deli- 
cate skin of the drum-head soon inflames the latter. 
Unfortunately, the worst thing which the patient can 
do is now usually done, for oil is poured into the ear. 
This feeds the fungus; in fact, many cases of the 
growth of this fungus are directly traceable to the 
use of oil for some previous ear-disease. The oil 
having been allowed to remain in the ear until it has 
become rancid, the fungus, of course, seeks the ear 
as a favorable place for growing. 

One of the best forms of treatment for an ear 
infested by the fungus Aspergillus is syringing with 



DISEASES OF THE EXTERNAL EAR. 75 

tepid or warm water. This not only allays pain, but 
it destroys and removes the parasite. 

Swabbing the ear and the resulting packing in of 
wax and skin has also been alluded to as a cause of 
disease in the canal and of the drum-head. The lat- 
ter is often thus scraped, excoriated, and inflamed. 
The writer has known both men and women to scrape 
off pieces of their drum-heads by the use of pins, 
hair-pins, and other improper means of so-called toi- 
let. The final result of all this is, a chronic ulcer on 
the drum-head and on the wall of the canal nearest 
the membrane. The ulceration is attended with the 
growth of granulations and little polypi, or ^^ proud 
flesh," as it is more commonly called, and a foul 
discharge. 

This ulceration usually extends to the bone, espe- 
cially if the picking and scratching are kept up by 
the patient ; and decay of the bone, a most obstinate 
form of disease, is established. The disease once en- 
grafted on the ear, the patient can do nothing him- 
self, alone and unaided, for his cure. 

It would be worse than useless to attempt to lay 
down here a course of treatment for such a patient to 
follow, because polypi, or the exuberant granulations 
attending an ulcer as described, must be removed by 
surgical skill, and only by it. 

The best advice that can be given here, is one that 
looks towards prevention rather than treatment. It 



76 HEARING, AND HOW TO KEEP IT. 

is from a knowledge of the vast amount of damage 
done to the ear by people themselves, that I can only 
repeat that caution so often given throughout these 
pages — do not pick and swab the ears. If you do, 
you will soon set up a disease which may be termed 
purely artificiaL An erroneous management of the 
ear, often begun for some i77iaginary evil, will surely 
lead to positive and most obstinate disease of the 
organ. 



CHAPTER II. 

DISEASES AND INJURIES OF THE MIDDLE EAR. 

PAIN has been often alluded to already, in the con- 
sideration given to the various diseases of the ex- 
ternal ear. But as the middle ear, especially the drum- 
cavity, is the part of the ear most frequently attacked 
by inflammation, the cause of earache may be said 
to lie usually in that cavity. Excepting boils in the 
ear, no pain is equal in severity to the excruciating 
earache produced by an inflammation in the cavity 
of the drum. It is here that most earaches in chil- 
dren arise. The severity of these cases is so great 
that, unless relief be obtained, a child will be thrown 
into spasms, or pass into stupor and unconsciousness. 
In some cases the brain becomes so much affected by 
the disease of the drum that the child dies. 

More usually, however, the mucus and pus arising 
from the inflammation distend the drum-head until 
it bursts, and there ensues relief from pain, but an 
impairment of hearing. The latter is not necessarily 
permanent. 

The causes of this disease of the ear in childhood 
7* 77 



78 HEARING, AND HOW TO KEEP IT. 

are chiefly scarlet - fever and measles. Teething, 
whooping-cough, and severe colds in the head or chest, 
also furnish a certain number of cases of earache, 
/. e. inflammation in the drum. Inflammations of the 
drum in adults are produced by exposure to cold, 
and the consequent ^^ catching cold." It may also 
attend pneumonia, and other lung-diseases in the 
adult. As has already been noted (p. 72), inflamma- 
tion of the drum-cavity may arise from cold-water 
bathing, especially if the cold water is allowed to 
enter the ear or nostrils. 

When the middle ear, or, more especially, that part 
of it called the drum-cavity, becomes inflamed, even 
talking, coughing, sneezing or eructation cause pain 
in the ear. There is more or less buzzing and singing 
in the ear, the patient's voice seems altered to him- 
self; there may also be a kind of echo in the ear, and 
the hearing begins to grow dull. Sometimes all of 
these symptoms precede the pain in the ear. 

After exposure to cold, an itching may be felt, run- 
ning from the throat to the ear. This sensation 
gradually increases, passing, however, from an itching 
into a darting pain, which localizes itself in the ear. 
In other cases, however, the pain starts off at a bound, 
directly in the ear, and the agony in the adult, as we 
are informed, is intense. It must be left to the imagi- 
nation, what infants and young children may suffer 
with inflammation of their drum. 



DISEASES OF THE MIDDLE EAR. 79 

Very often the pain is cut short, both in adults and 
children, by the spontaneous rupture of the drum and 
the discharge of matter. As this disease and this 
result, viz., discharge from the ear, occurs most com- 
monly in early childhood, and forms a numerous class 
of patients, it demands more than a passing word, 
especially as with the earache and discharge begins a 
train of possible evils, not dreamt of by patients, and 
very imperfectly understood by the mass of practition- 
ers of medicine. 

So far as my experience goes, and that, too, of my 
colleagues in otology, this form of ear-disease is usu- 
ally neglected by the general practitioner, and hence 
it becomes chronic, /. e. it persists and becomes 
worse. A child will not outgrow a running from the 
ear any more than he would outgrow a broken bone. 
It is admitted that sometimes a child has an earache, 
followed by a discharge, which, after a few weeks or 
even months, seems to undergo a spontaneous cure. 
But these cases are rare ; while chronic cases, which 
have lasted any length of time from infancy to mid- 
dle life, are extremely numerous. Another favor- 
ite subterfuge of mismanagement is to say that if the 
discharge be cured or *^ dried up," the patient will 
be injured thereby. To this it can be said that, if 
a discharge is not checked, hearing, health, and life 
are in danger. No one hesitates to have a sore and 
running eye healed, for, if it be not healed, the eye 



8o HEARING, AND HOW TO KEEP IT. 

will literally run out. The same should be the care 
for a running ear, for not only is the odor from a 
discharging ear extremely offensive, but the ear, too, 
like the eye, if neglected, can and does run out, and 
hearing goes. A neglected, running ear has this 
additional evil about it, that in time the inflamma- 
tion works inward to the brain, and death ensues. 
This latter occurrence is not uncommon in chronic 
ear-diseases, with a constant running from the ear. 

The natural question arising now is, ^^What shall 
be done to cure earache arising from inflammation in 
the drum?'^ While attempting to answer this ques- 
tion, it will be well to tell the patient or his friends 
what not to do, as well as what may be done. 

In the early stages of earache from closed Eu- 
stachian tube and congested drum-cavity, a vigorous 
blow of the nose — the air being held in as much as 
possible, so as to force it backward into the throat — 
may give relief by opening the Eustachian tube. If 
this is not successful, as it may not be in young 
children, and if it cannot be done at all, as in the 
case of infants, air may be blown into a nostril of the 
sufferer in the following way : Take a short, clean 
tube of any kind, rubber preferred, about a foot long 
and with narrow diameter, and place one end of it 
in the nostril, on the side of the affected ear, and 
gently but firmly stop the opposite nostril with the 
finger. Then let the surgeon or the parent, or whoever 



DISEASES OF THE MIDDLE EAR 8l 

is performing this operation, blow, from his mouth, 
into the outer end of the tube. The child will 
usually cry, but this act on its part only aids in 
opening the Eustachian tube. One blast from the 
mouth of the operator through this tube, will usually 
suffice to inflate the Eustachian tube. This, some- 
times, is all the treatment required to cure an ear- 
ache. Of course there are other surgical means, but 
they are not to be mentioned here, as our purpose is 
only to give those procedures in treatment which 
could be carried out by an experienced nurse or non- 
professional person, in the absence of a surgeon. 
However, the pain may not be entirely due to the 
closure of the tube, but to absolute inflammation in 
the drum-cavity. The treatment just proposed would, 
of course, now fail to give all the relief desired, 
though it would in most any case, in the earlier 
stages, give some relief to the pain ; but the latter 
would soon return, especially towards night, with 
greater severity, if the cavity of the drum be inflamed. 
Most relief will be obtained by syringing the ear 
gently with very warm water, or very warm water 
may be poured into the ear from a spoon. Some- 
times breathing into the ear with the mouth wide 
open, and close to the ear of the sufferer, will give 
relief to earache. In addition to these methods, 
warm water and laudanum, equal parts of each, may 
be dropped into the ear and allowed to rest there a 

F 



82 HEARING, AND HOW TO KEEP IT. 

few minutes. Cloths wrung out of very warm water 
may be placed around the painful ear, but never over 
it. If laid over it, such dressings tend to produce 
'* proud flesh " in the ear. 

But beyond these modes of domestic treatment for 
earache no one should go, without consulting some 
one who understands the structure of the ear and the 
treatment of its diseases. 

This may seem very odd to those who have been 
used to dropping all kinds of oils, and worse than 
useless materials, almost too numerous to name, into 
the ear when it aches, and who then let it alone when 
it begins to run and smell, and really demands treat- 
ment. These it may be well to tell what not to do. 
It would, indeed, be vastly better, in many cases, if 
the ear were let alone before it begins to discharge 
matter, instead of after it has begun to run. 

Lancing the Drum. — To those suffering with ear- 
ache from pent-up matter in the drum, the knife 
brings the quickest relief When the matter has 
formed behind the drum-head, and the latter has not 
spontaneously burst, it must be perforated. The 
delicate needle-like knife of the surgeon must now 
be run into the distended drum, not only because it 
gives relief to pain and the deafness, but because the 
surgeon can usually choose a better point for the 
discharge than nature, and he can make a smaller 
and safer opening in the drum. It is then often 



DISEASES OF THE MIDDLE EAR. 83 

the choice between a prompt relief from a small tem- 
porary opening, or long continued agony, and finally 
a breaking down and total destruction of the drum- 
head, with the attendant probability of great loss of 
hearing at last. The surgeon is right, therefore, when 
he proposes to lance your drum, if it is painful and 
distended with matter. Do not fear; his cut will 
soon heal, and your drum will be safe. This short 
exhortation seems demanded on account of the wide- 
spread, though entirely unjust, prejudice against per- 
forating the inflamed drum-head. 

Whai not to do, — When speaking of diseases of the 
external ear, caution was given against putting in a 
number of substances very generally and very errone- 
ously resorted to. (See p. 74.) 

Among the articles there mentioned was sweet oil ; 
and it must be said here that this is one of the articles 
not to be dropped into the ear for earache. For 
it will not cure the pain, to begin with, and it is 
greasy, and hence, for the treatment of the ear, 
dirty. It is heavy, sticky, and cloggy. Hence, in 
cases of tenderness of the drum, the pain is rather 
increased, than otherwise, by putting oil into the ear. 
If the surgeon is finally required to examine the ear 
after oil has been dropped into it, he will be unable 
to see the drum-head plainly, on account of this ob- 
struction. Hence the oil must be removed, which is 
not easily done without soap, water, and a syringe. 



84 HEARING, AND HOW TO KEEP IT. 

This latter manipulation may give pain, when it 
might not have occurred, had oil not been put in 
the ear. If, however, the pain abates, and the sur- 
geon is not called in, the oil is forgotten, and al- 
lowed to remain in the ear. Here it soon becomes 
rancid, and hence a fit soil for the growth of the fungus 
Aspergillus. The latter, as soon as it begins to grow, 
excites in the ear a painful and serious inflammation. 
(See p. 73.) 

What has just been said about sweet oil, may be 
with equal force urged against the use of any other 
fat or oil in the ear. They do no good to the pain, 
and in the end they may breed disease in the ear. 
All the seeming and vaunted benefit connected with 
the use of fats and oils about the ear, is due simply 
to the heat communicated by them to the painful ear, 
since they are usually heated before they are dropped 
into the inflamed organ. 

There is also a number of other injurious matters 
which are often, but should not be, put into tiie ear 
when it is inflammed and aching. 

Prominent among these is the core of a roasted 
onion. Here the heat of the roasted vegetable gen- 
erally gives relief; but all of the onion put into the 
ear is scarcely ever entirely removed. Large pieces 
are sometimes forgotten, or they defy the efforts of 
the patient at removal, so that they remain in the 
ear until they putrefy. Then the intolerable odor as 



DISEASES OF THE MIDDLE EAR. 85 

well as the discomfort arising from the remains of the 
onion, usually call the attention of the patient and 
his friends to the ear, and the surgeon's aid has to be 
asked for. 

In some instances, the subsequent inflammation, 
excited by the use of this favorite domestic treat- 
ment, is so extensive as to excite ulceration of the 
auditory canal and of the drum-head, and in some 
cases proud flesh springs up. 

Not only the onion, but various other vegetable 
matters, as mashed carrots, potatoes, and the like, are 
applied to and put into the ear. The same results, 
as just ascribed to the use of onion, may also arise 
from the use of any vegetable matter put into or 
poulticed over the ear for relief of pain. 

All of these matters are forms of poultice, and 
every one should learn that a poultice over either 
the ear or the eye, will act injuriously on the organ. 
If a poultice of any kind be placed over an inflamed 
ear for a short time, even for a few hours, irreparable 
injury may be done to the organ. This will be mani- 
fested by a mass of granulations (proud flesh) spring- 
ing up in the canal, the breaking down of the drum- 
head, and the falling out of the little bones of the 
ear. It is needless to say that this destroys forever 
the hearing. Not only may the hearing be de- 
stroyed by such mismanagement of the ear, but a 
8 



86 HEARING, AND HOW TO KEEP IT, :■_ 

M 

chronic running from the ear may be thus estabf- 
lished. f^ 

Chronic Deafness with a Discharge from the Ed'r. 
— When such a chronic discharge from the ear has 
become fully fixed on the ear, the usual course on the 
part of patients is to desist from all treatment. And 
this is hardly to be wondered at, for their experience 
with domestic treatment has not been satisfactory. 
But now is the time that something should be done 
to rectify mistakes in treatment, and to try to check 
the discharge. This is not always easy to do, espe- 
cially if the drum-head is largely perforated, as it is 
apt to be, or if a polypus has sprung up in the ear. 
Treatment may be continued indefinitely, without 
avail, if a polypus be in the ear. It must be removed 
from the ear before the discharge will cease, and then 
a discharge is usually easily checked. In many cases 
the discharge seems first to excite the growth of the 
polypus, and then the latter seems to keep up the 
running from the ear by the irritation it sets up. A 
polypus may be attached to the walls of the canal, 
the drum-head, or to the walls of the drum-cavity — 
usually the latter. It looks, certainly in its earliest 
stages, and even for a long time, like a miniature 
cherry fastened to its stem. 

After this chronic running has kept up for a time, 
and after a polypus has grown, or whether it has or 
not, the bone may become diseased, the hearing 



DISEASES OF THE MIDDLE EAR. 8/ 

gradually fail, and, as already said, the brain may 
become diseased, and death ensue. All these state- 
ments should not unduly alarm the reader, but only 
induce him not to neglect his ear or his child's ear, 
nor yet to do the wrong thing for it when inflamed. 
It may very justly be said that inflammatory diseases 
of the ear, like inflammatory diseases elsewhere, are 
amenable to proper treatment, and also that there are 
men in every community fully able to treat them, and 
to these an ear-disease should be entrusted as soon as 
possible. Science of the present day has placed in 
the hands of the educated surgeon special means for 
the relief of ear-diseases, which he alone can apply. 
It would therefore be very plainly out of place to 
mention them here, where it is supposed a brief out- 
line of hygiene, rather than treatment of disease, is 
laid before the non-professional reader. 

There is one direction that should be given here 
for the management of an ear affected with a chronic 
discharge. It is to keep it perfectly clean by means 
of syringing once or twice daily, or oftener, if neces- 
sary. This will tend to keep down the disease, and 
place the ear in a better condition for proper treat- 
ment when a surgeon can be called on for aid. How 
to syringe the ear has been described on pages 62 and 

63. 

All oils are of no avail in checking a running from 
the ear. They only serve to block up the auditory 



88 HEARING, AND HOW TO KEEP IT, 

canal and increase the liability of putrefaction of re- 
tained matter, which will in turn bring about at least 
a. disagreeable odor. When this latter condition is 
once fully established, the ear may attract flies, which 
will enter the ear, deposit eggs, and in a short time 
thereafter maggots will attack the more delicate parts 
of the canal of the ear and the drum-head, producing 
the most intense agony. 

The constant presence of this offensive matter in 
and about the ear certainly tends to poisoning the 
blood of the patient, and not uncommonly death is 
the direct result of this form of ear-disease. 

A discharge from the ear, as described above, can- 
not exist without a perforation in tiie drum-head. 
After the discharge ceases this perforation may heal, 
but in many long-continued cases it does not. In 
such cases, after the discharge has ceased, the hearing 
may be improved by wearing what is known as a 
false or artificial drum. The best are the simplest, 
consisting of cotton pellets, to be adjusted by the 
surgeon at first, and possibly thereafter by the patient. 
There are numerous other forms, consisting of rubber 
discs and wire handles, which are not only useless in 
most cases, but often produce positive injuries by the 
irritation which they create in the ear. 

Chronic Deafness without Dischai'ge f7^om the Ear, 
— Very often earache is not attended by a discharge. 
This is equal to saying there has been no rupture of 



DISEASES OF THE MIDDLE EAR. 89 

the drum, though matter may have formed behind it. 
In these cases the inflammation goes down, either of 
its own accord or because the treatment has allayed 
it. The matter, therefore, which may have formed 
is small in quantity, and has either escaped into the 
throat by the Eustachian tube, or still remains in, 
though not filling, the cavity of the drum. In these 
cases the ear continues to feel stuffed up, and is liable 
to feel every change in the weather, or every cold the 
patient may catch. Such cases are the foundation of 
chronic hardness of hearing, and are usually found in 
connection with chronic catarrhal disease of the throat 
and nose. There is more or less buzzing or singing, 
either steady or with the pulse, in both ears or in one 
only, and sometimes a dizziness in the head, — all of 
which greatly distress the patient, and frequently de- 
press his spirits. With this form of ear-disease, ear- 
dizziness may be a prominent attendant. This kind 
of dizziness will be more fully spoken of under Aural 
Vertigo. 

Gradually, too, the hearing fails in one or both 
ears ; the patient begins to lose some words, first at 
church or in lectures ; then conversation begins to be 
attended with some difficulty; a sense of confusion 
in the head comes on when in the midst of great 
noises, as in the street, or when in a large room filled 
with a number of talking people. 

This kind of ear-disease, chronic catarrh of the 
8* 



90 HEARING, AND HOW TO KEEP IT, 

ear, is the most common cause of hardness of hearing 
and deafness, and as such is the object of many forms 
of treatment and much quackery. It may be said at 
the outset that nothing can be put into the external 
ear which can in any way benefit this form of deaf- 
ness. As a rule, any kind of drops put into an ear 
affected with chronic catarrh will do more harm than 
good. 

The disease lies beyond the drum-head, in the 
drum-cavity and in the Eustachian tube. Now, as 
the drum-head shuts off, air-tight, the middle ear 
from the external ear, drops put into the latter can 
by no means reach the former. They only fall on 
the drum-head and irritate it. 

Treatment to be of avail must be directed to the 
throat, the nostrils, and the Eustachian tube ; possibly 
through the latter to the drum-cavity. But that is 
a matter to be left to the judgment of the surgeon. 

The body must be properly, that is, warmly, pro- 
tected with heavy under-clothing, a matter not to be 
specially described here, and the feet must be most 
carefully kept warm and dry. The condition of the 
feet has a most intimate relation with the welfare of 
the throat and the ears. 

If, on going into the open air, the ear or ears 
should feel the cold until they ache, then they must 
be protected either by ear-muffs, a veil, a scarf, or a 
piece of cotton in the mouth of the canal of the ear. 



DISEASES OF THE MIDDLE EAR. 9 1 

Of course, mere coldness of the auricle in very cold 
weather is to be expected, and is not specially preju- 
dicial to hearing. What is alluded to here is ear- 
ache, deep in the ear and throat under the ear and 
jaw, and hence the words of caution as to protection. 
But in no case must cotton be worn in a running ear. 

Catarrh Explained. — The word catarrh is used 
here in reference to diseases of the ear, and will be 
thus used in future. It will therefore be necessary to 
say that catarrh as used here does not refer to the 
offensive disease of the nose and head, to which this 
word is so constantly applied, especially in news- 
papers. The disease in that case ought to be called 
*^ fetid catarrh of the nose." Catarrh really means 
a '' running," and hence it is applied to inflammation 
of the mucous membranes generally. As this mem- 
brane is the chief seat of disease in ear-disease and 
deafness, these complaints have justly been termed 
'^ catarrh." But there is a wide difference between 
fetid catarrh of the head and chronic catarrh of the 
ear. In fact, they are rarely found together in the 
same individual. 

This explanation of the difference in these diseases 
is demanded, because patients are often misled and 
imposed upon by not knowing that catarrh does not 
necessarily mean a disease of the head, with an offen- 
sive odor. This want of proper knowledge on their 
part, and avarice on the part of unscrupulous quacks, 



92 HEARING, AND HOW TO KEEP IT. 

often lead the suffering into doing the wrong thing 
for their chronic ear-catarrh and deafness. Hence 
it may be well to state what should not be done in 
such cases. 

It may be said with absolute certainty that all so- 
called catarrh-snuffs, sold with loud advertisements 
and bright coverings, are injurious to the nose and 
ears. The same may be said of all so-called catarrh 
remedies in fluid form which are given to be snuffed 
into the nose. 

In fact, nothing should be forcibly snuffed into the 
nostrils, not even cold water. Man is a warm-blooded 
land animal, and therefore not made to endure 
taking cold water into his breathing passages nor 
into his external ear. All mammals (/. e. animals 
of the class to which man belongs), such as seals, 
beavers, etc., when obliged by their habits to go 
under the water, hold their breath. What is still 
more in favor of the safety of their ears, they possess 
either the ability to voluntarily close the external ear, 
or it is so small and crumpled about the mouth of 
the auditory passage as to keep water out. This can 
be seen in seals and otters. In this connection it 
may be stated that hunting-dogs, trained to dive, 
usually grow deaf after a few years of such service, 
since they are not provided by nature with the means 
of protecting their drums. In many cases of chronic 
catarrhal deafness, combined with chronic catarrh 



DISEASES OF THE MIDDLE EAR. 93 

of the throat and nose, fluid applications, as recom- 
mended by the surgeon, are of value. But these 
should never be applied cold. Their coldness, of 
itself, is very likely to produce catarrhal disease 
rather than cure it. 

There is an instrument called the nasal douche^ 
much used and much abused. It consists of a vessel 
to hold a fluid and a tube to convey the latter to the 
nostrils. By allowing a fluid to enter one nostril, 
the mouth being open, the current of fluid thus 
conveyed to the nose flows through one nostril into 
that part of the throat, above the palate, called the 
nasal pharynx, bathing that region, and out by the 
other nostril. This physiological fact, often em- 
ployed by the regular surgeon with advantage, is not 
only known to, but also utilized by, the quack, and 
instruments for performing this operation are largely 
sold, under various names, in some parts of our 
country. Most of these instruments are imperfect, 
are unaccompanied by proper directions for using 
them, and are sold by persons unable to give proper 
instructions to patients who buy and employ them 
without the advice of a physician. 

When properly constructed and applied, the nasal 
douche is of great value and perfectly safe j but when 
improperly made and unskilfully used, it leads to 
direful results to hearing. The best douche consists 
of a glass bottle, to the side of which, close to the 



94 HEARING, AND HOW TO KEEP IT. 

bottom, an opening is made for the attachment of a 
rubber hose, about 2^-3 feet long, to the free end of 
which an olive-shaped glass nose-piece is fastened. 
Of course, its popular use is for nasal catarrh, or 
'^catarrh in the head," as some people call it. But 
the writer constantly meets with serious diseases of 
the ear, produced by the improper use of the nasal 
douche. 

The chief mistake in these cases has been that the 
fluid injected into the nose has been cold, and also 
the vessel holding the fluid has been held too high. 
As has been said, the fluid thus used, or in any way 
dropped, poured, or put into the nose, must be warm. 
If the vessel is held so that the level of the fluid is 
higher than the eyes of the patient, the fluid will 
probably enter one or both ears through the Eusta- 
chian tube. Now if this happens, whether the fluid be 
hot or cold, the ear will most probably be inflamed 
by it. A sense of fulness is felt, with pain sooner 
or later in the ear, and perhaps also in the brow, 
the top of the head, or even in the back of the head. 

The fluid thus employed should rarely if ever be 
anything more than warm water, to which, perhaps, 
a little salt may be added, in the proportion of a 
teaspoonful of the latter to a pint of water. After 
using the douche, the patient should remain in his 
room for fifteen minutes, and this room should never 
be a cold one. But the safe plan to pursue is never 



DISEASES OF THE MIDDLE EAR. 95 

to use a nasal douche unless directly ordered by a 
competent surgeon, and he will not tell the patient 
to tie the bottle to the chandelier and then let the 
water run through the nose. The physician who 
thus advised his patient (and such an instance came 
under the writer's observation) was not competent 
to prescribe the nasal douche. 

Catarrh Snuffs. — So far as these are concerned, it 
can be said that both the dry powders and fluid 
forms for snuffing into the nostrils constantly produce 
ear-diseases. Not long since, the writer was con- 
sulted by a gentleman who, for a slight catarrh of 
•the nose, had bought and used one of the numerous 
advertised remedies for this disease. One powerful 
snuffing of the fluid drew it directly into the Eusta- 
chian tube, and set up a sudden and painful inflam- 
mation in the drum. 

As these so-called remedies do no good to the dis- 
ease in the nose, and as they may do harm to the 
ears, the writer feels that he must proclaim his dis- 
approval of them, on the ground of their positive 
harmfulness. 

Diseases of the Eustachian Tube, — The diseases 
of the Eustachian tube amount to diseases of the ear. 
A cold in the head or a sore throat may, at any time, 
affect the Eustachian tube, as they are lined with the 
same mucous membrane, and are of course very close 
together. It is the simultaneous aflection of the Eu- 



96 HEARING, AND HOW TO KEEP IT. 

stachian tube in an ordinary cold in the head, that 
gives the stuffed feeling and alteration of sounds in 
the ear. This stuffed feeling should not be neglected, 
if it does not pass off in a few days. Should it con- 
tinue, it will show that more than ordinary swelling 
has occurred in the tube, and it will be found that 
the hearing is slightly impaired. 

Usually, as the cold passes off, this peculiar feeling 
in the ear or ears passes away. If this does not take 
place, and the tube is allowed to remain closed up, 
with the consequent stopped feeling in the ear, the 
tube falls into a chronic condition of inactivity and 
an inability to open itself at every act of swallowing. 
If this closure is allowed to continue, the drum -head 
falls in, and a vacuum forming in the drum- cavity, 
the bones cannot swing to and fro, and deafness be- 
gins to come on. The entire hearing apparatus then 
falls out of use, and a proper exercise of its func- 
tion. Like every other part of the body, if the ear 
is kept out of proper exercise, it loses the ability to 
act ; and if now the tube is opened, and air is allowed 
to enter once more the drum-cavity, it will be found 
that the hearing is greatly reduced. 

This is supposed to be due to the stiffening of the 
bones of the ear. From what has been said of their 
function as sound-conductors, it is evident, that if 
they are stiffened or impeded in any way in their vi- 
bratility, the hearing must become impaired. This 



DISEASES OF THE MIDDLE EAR. 9/ 

would not necessarily be the case had the Eustachian 
tube been promptly opened. The latter can be done 
most efficiently by the inflation-bag of the surgeon. 
In children this tube is often closed up, and kept 
closed because their nostrils are stopped up with 
mucus. The child then begins to breathe through its 
mouth, which causes a further obstruction of the nos- 
trils by a collapse, so to speak, of their outer and soft 
walls. The mucus is thus allowed to harden and to 
become firmly fixed in the breathing passages, the 
mouth and throat become dry and diseased from con- 
stantly breathing directly through the mouth, and 
thus irritation is kept up and passes further into the 
ear from the throat behind the palate. 

The stoppage of the Eustachian tube from all these 
causes, especially in little children, is one of the most 
fruitful sources of earache and deafness. As will be 
further shown under the hygiene of the ear, breathing 
through the nostrils is necessary to hearing and good 
health, while breathing through the mouth is not only 
disfiguring to the countenance, but very injurious to 
the hearing and the throat, and finally may bring on 
lung-diseases. 

Tonsils and Palate. — With diseases of the Eu- 
stachian tube, the nose, and the middle ear, there is 
often found enlargement of the tonsils and the pal- 
ate. We then often hear the expression that the 
*^ palate is down," by which is meant that the little 
9 G 



.98 HEARING, AND HOW TO KEEP IT, 

grape-like appendage in the middle of the edge of 
the palate is elongated by disease. This may be 
either a temporary swelling or a permanent enlarge- 
ment. 

Without entering into a discussion of diseases of the 
tonsils or the palate, it is necessary to state that en- 
larged tonsils have very little, if any, part in the pro- 
duction of deafness. They are usually enlarged from 
the effects of the same disease of the mticous mem- 
brane, or of the system in general, which has also 
caused disease in the ear. Cutting out the tonsils is 
not going to cure the deafness. If these organs of 
the throat become too large, they can be made smaller 
by caustics much more advantageously and painlessly 
than by means of the knife. 

When the uvula of the palate becomes longer than 
natural, and the palate is then said to be *'down," 
an irritation is set up in the throat, and the patient 
not only has a tickling cough, with a sensation as 
though something were sticking in his throat which 
he cannot remove, but an irritation in the throat, 
caused by the constant rubbing of the elongated pal- 
ate against the walls of the throat, is kept up and 
transmitted to the upper part of the throat behind the 
nostrils and to the Eustachian tube. When the latter 
becomes diseased, as we already know, the ears are 
in danger, and the hearing may become greatly af- 
fected. 



DISEASES OF THE MIDDLE EAR. 99 

Clipping off the superfluous tip of the uvula — as 
much as the -^^ or | of an inch — will do away with 
this mechanical irritation in the throat. As, what is 
to be cut off, is only the surplus of mucous mem- 
brane, and not muscle, only good can arise from the 
operation. But, unfortunately for this operation and 
for numerous patients, they have allowed their entire 
uvulae to be cut off, and the result has been not only 
a painful sore-throat, but the palate has been deprived 
of an important appendage which should never be 
entirely removed. When, then, this appendage is too 
long, only enough is to be removed to render the 
remnant of an ordinary size, and thus prevent the 
tickling and irritation of an unnaturally long one. 
All surgeons are supplied with the means of rapidly 
cutting off the tip of the uvula. The operation is 
instantaneous and painless, and when promptly done 
may prevent deafness. 

Mastoid Disease. — When we were considering the 
anatomy and physiology of the middle ear, allusion 
was made to the mastoid bone (see p. 33) and its 
close connection with the tympanic or drum-cavity. 
This part of the middle ear may also become the seat 
of a most painful and dangerous inflammatory disease. 
This bony cavity behind the drum, felt as a promi- 
nence or lump behind the ear, is hollow, or, at least, 
a collection of hollow cells, and is lined, like the 
cavity of the drum, with mucous membrane. The 



100 HEARING, AND HOW TO KEEP IT, 

latter very easily partakes in the diseases of the drum, 
especially when the latter is the seat of a chronic or 
long-continued discharge. In such cases the bone 
becomes diseased and the cavity of the mastoid cells 
becomes choked with pus. The pain is usually in- 
tense, as the matter, being confined in a bony case, 
cannot escape. This cavity on its inner part is in 
close contact with a thin wall of Bone, which sepa- 
rates the cavity from one of the great blood-vessels 
of the brain. This inner wall, being so much thinner 
than the outer wall behind the ear, gives away 
soonest to the ravages of the disease, and matter thus 
passes from the mastoid cavity to the brain. In fact, 
this disease is one of the bad results very likely to 
follow neglect of a running ear, or, in fact, of any 
kind of acute inflammation of the middle ear. 

This is not, however, a very rapid disease, and, as 
a rule, the patient and his physician have ample 
warning of danger in attacks of pain. If these are 
not properly relieved, /. e. if the mastoid cavity is 
not properly drained, the pain becomes more severe 
and constant, the patient fails rapidly, at last, in 
strength ; his blood seems to be poisoned, abscesses 
may form in his neck or elsewhere in the body, 
delirium and unconsciousness ensue, and finally he 
may die in convulsions. In order to prevent this 
final and fatal result, when the pain shows signs of 
becoming constant and intense, and when the pro- 



DISEASES OF THE MIDDLE EAR. lOI 

tuberance behind the ear becomes tender to pressure 
from the finger, the patient should lose no time in 
consulting a surgeon, and the latter can give relief 
to pain and ward off danger by making a hole in the 
bone behind the ear, and letting out the pent-up 
matter. Where this operation has been performed 
in time, life has been saved ; but where it has not 
been permitted, death has ensued.* 

* See papers on this subject by A. H. Buck, M. D., of New 
York; Archives of Oph. and Otology, Vol. III., 1873; J- Orne 
Green, M. D., of Boston, Boston City Hospital Reports, Sec- 
ond series, 1877; Dr. H. N. Spencer, of St. Louis, Transac- 
tions Medical Society of Missouri, 1875. 

9* 



CHAPTER III. 

DISEASES AND INJURIES OF THE INTERNAL EAR, 
INCLUDING DEAF- DUMB NESS. 

DISEASES and injuries of the internal ear are not 
very numerous, nor are they clearly understood. 
In this chapter, therefore, it shall be our purpose to 
consider some of those aural symptoms which usually 
have been called nervous phenomena, though they 
are not apparently as closely connected with disor- 
ders in the labyrinth of the ear as they were once 
thought to be. It shall also be our endeavor to 
allude, at least, briefly, to some diseases manifestly 
connected with the labyrinth. 

In the closing part of the chapter, we shall also 
give a short account of deaf-dumbness, and the causes 
which may lead to this affliction. Throughout the 
following pages the endeavor will be constantly made 
to point out how the maladies alluded to may be 
alleviated or, if possible, prevented. The general 
management of deaf-mutes, especially their education, 
will be referred to in the last part of the book. 

Noises a7id Rmging in the Ears and Head. — There 



DISEASES OF THE INTERNAL EAR. IO3 

is no symptom, deafness alone excepted, more fre- 
quently complained of among aural patients than 
noises or ringing in the ears. There is no disease 
of the ear which may not produce this disagree- 
able sensation, and there are other diseases, not 
purely aural, which sometimes provoke this sensation 
in the ear. It is, of course, a morbid or perverted 
sensibility of the nerve of hearing. I do not mean 
that the nerve is always the seat of disease — it is 
usually not — in cases of this abnormal and dis- 
agreeable sound in the ear or ears ; but the nerve of 
hearing is improperly excited or impressed in such 
cases, and the causes are numerous. 

All the forms of ear-disease already mentioned, 
may produce ringing, hissing, etc., in the ear, and 
sometimes these noises seem to extend into the head. 
These noises are likened to sounds with which the 
sufferers are most familiar, excepting among the in- 
sane. The latter may imagine their aural noises to 
resemble anything. 

It is important for the reader to know that some 
of these noises in the ear — subjective noises, as they 
are termed, because originating in the person or sub- 
ject, and audible only to him — are easily curable, 
while others are hard, or even impossible to cure. 
Yet, in most cases, noises in the ear will in time 
cease. 

It should be borne in mind, however, that noises 



I04 HEARING, AND HOW TO KEEP IT, 

in the ear, accompanied by hardness of hearing, are 
indicative of aural disease ; but that those sounds in 
the ear, unattended with alteration of hearing, are due 
to some derangement of the system, most probably in 
the stomach or in the nervous system. Noises in the 
ear always demand attention, especially if they become 
persistent. An ordinary passing ringing or cracking 
sound in the ear, calls for no attention. 

It will be in place here to say that in some very 
rare cases, — there are only about a dozen on record, — 
the muscular structures in the ear and in the Eu- 
stachian tube undergo spasmodic twitchings, which 
produce a snapping sound, not only audible to the 
patient, but also to those near him. The writer 
once observed such a case, in which the snapping 
sounds were audible to him ten or twelve feet away 
from the patient. 

All subjective sounds can be treated only by the 
physician. It may be said that any attempts to 
cure these noises by putting drops in the ear, will, 
in all cases, increase the noises. If the noise is due 
to the presence of a foreign body in the external ear, 
the removal of the offending matter will quell the 
noises, as ringing, singing, etc., which may have been 
perceived in the ear. 

The most obstinate noises in the ear, however, are 
those produced by a disordered circulation of blood 
in the ear. This is especially the case in catarrhal 



DISEASES OF THE INTERNAL EAR. I05 

diseases of the drum-cavity, (p. 78.) Ringing in the 
ear is also an accompaniment of some diseases of the 
internal ear, /. e, of the labyrinth. This form of 
ringing in the ear is very likely to be attended with 
vertigo or dizziness. 

Dizziness in Ear-Disease. — Dizziness, accompanied 
sometimes with reeling, nausea, and vomiting, may 
be an attendant of various forms of ear-disease. In 
rare cases, in addition to these symptoms, there may 
be stupor, unconsciousness, or epileptic seizures, and 
the patient may be thought to be in an ordinary epi- 
leptic fit. Foreign bodies in the ear have produced 
not only symptoms of fits, but also temporary paraly- 
sis. The removal of the foreign substance from the 
ear, has been followed by an instantaneous and per- 
manent disappearance of all these peculiar phenomena. 
It can be said that dizziness may be produced by dis- 
ease in the external, the middle, or in the internal 
ear, and also by disease in the nerve of hearing it- 
self. 

The general term applicable to all cases of vertigo 
arising from these causes, is Aural or Ear Vertigo. 
It remains for the careful search of the physician to 
determine where the true cause lies, that is, in what 
part of the ear, and then to assign a definite term to 
the malady. One of these terms, '^ Meniere's disease," 
is applicable only to a disease of the semicircular ca- 
nals, an affection very rare and difficult of diagnosis. 



I06 HEARING, AND HOW TO KEEP IT, 

But this term, ^'Meniere's disease," is constantly and 
very erroneously applied to all forms of aural vertigo. 

If aural vertigo be due to disease in the middle ear, 
its true nature must be determined, then combated 
and cured. Disease of the throat-muscles, extending 
to the small muscles of the ear-drum, retention of 
matter in this cavity, and stoppage of the Eustachian 
tube, and a consequent vacuum in the drum, will pro- 
duce giddiness. 

This is due to the pressure conveyed to the water 
in the labyrinth, and thence to the natural fluids in 
and around the brain, and to the brain itself. 

If this abnormal pressure in the labyrinth is kept 
up long, it will end in chronic disease of the ends of 
the nerves in the various divisions of the internal ear, 
and constant tendency to attacks of ear-vertigo. 

Tumors of the brain, near the auditory nerve, and 
tumors in the nerve itself, produce not only a variety 
of general symptoms, but also marked symptoms in 
the ear, as ringing, and absolute deafness with ver- 
tigo and staggering. The tumor may continue for 
years without a fatal issue. 

lyeatment of Aicral Vei^tigo. — Both physician and 
patient should be careful not to ascribe to '' bilious- 
ness" the symptoms arising in aural vertigo. Yet 
this mistake is constantly made, and consequently the 
wrong treatment followed. It may be said that a 
treatment beneficial in an attack of so-called **bil- 



DISEASES OF THE INTERNAL EAR. lO/ 

iousness/' which in some respects an attack of aural 
vertigo closely resembles, is absolutely injurious in 
the latter disease. 

If aural vertigo be due to a foreign body in the ex- 
ternal ear, removal of the offending object will cure 
the vertiginous and any other symptoms excited by 
the irritation in the outer ear, as already stated. 

When due to disease in the middle ear, as described 
on page io6, these symptoms can be successfully 
treated. The throat disease should be cured, and if 
there be foreign matter in the drum, it should be 
removed. When a vacuum exists in the drum-cavity, 
opening the Eustachian tube will ventilate the cavity 
of the tympanum and do away with the vacuum. 
Diseases of the labyrinth are not so easily overcome, 
and hence the vertigo arising from them is more 
obstinate than in the previously-named diseases. 
The symptoms arising in the ear, in cases of tumor 
of the brain and auditory nerve, or in either one 
alone, are incurable. 

But it should be stated here, that as a preventive 
of aural vertigo of the last form, imprudent exposure 
after excessive heating should be most carefully 
avoided. It is a most significant fact, that numerous 
cases of tumor of the auditory nerve have been 
directly traceable to cooling off the exhausted body 
after great exposure to heat and the consequent 
perspiration. 



I08 HEARING, AND HOW TO KEEP IT, 

This direful result has followed upon a careless 
falling asleep with the head on the window-sill on 
a summer night, after the body had been fatigued 
and heated by the exhausting temperature of the day, 
as in the case of a woman related by Dr. Boettcher, 
of Germany. A post-mortem examination revealed 
a tumor in the brain. One of the most marked cases 
of aural vertigo from disease in the internal ear 
which the writer has observed, occurred in a gentle- 
man who retired with only a sheet for covering after 
being exhausted and heated by an oppressive day in 
June. He lay in a draught and exposed to the cool- 
ing air of the mountains, where he happened to be 
at that time. As every one should know, the radi- 
ation of heat after a hot day is very great in 
mountainous districts. This had such a bad effect 
on the body of the patient alluded to as to render 
him stiff and sore. In a few hours after this expo- 
sure, aural symptoms — ringing, deafness, dizziness, 
nausea, and vomiting — set in. Total deafness of one 
ear, with tendency to dizziness, continued in this 
case. 

Injuries to the head may be the cause of a tumor 
of the auditory nerve, and consequently of the worst 
forms of deafness and aural vertigo. 

Effects of Concussion on the Internal Ear, — The 
effects of concussion on the ear, but especially upon the 
drum-head, have been alluded to on p. 67. Many 



DISEASES OF THE INTERNAL EAR, IO9 

of these cases, in which the drum-head is injured by 
concussion, also sustain injury in deeper and more 
tender parts, viz., in the labyrinth and in the auditory 
nerve. Thus a '' box on the ear," a blow on the ear 
or head of any kind, or a fall may be the direct cause 
of concussion and permanent deafness. Sometimes 
the deafness is total as well as sudden. These cases 
rarely recover hearing under any treatment, and it 
is doubtful whether anything could have been done 
to prevent the loss of hearing, had treatment been 
instantly applied. Where, however, the deafness is 
only partial, and the ringing in the ear keeps up for 
some time after the concussion, no matter what its 
nature may have been, treatment may do much 
towards restoring the hearing. But whatever is to be 
done must be done at once. In such cases, small 
doses of strychnia are probably our best means of 
treatment. 

Deafness from concussion, as a tumble down-stairs 
in childhood, or from a severe blow of any kind on 
the head, may be the foundation of deaf-dumbness, if 
the injury occur before the child has learned to talk. 
And even after a child has learned to talk, if a total 
loss of hearing occur, let us say before the sixth year, 
the child ceases to talk. Not being able to hear, it 
loses the disposition as well as the incentive to talk, 
its vocal organs fall into disuse, and, though it may 
always retain the ability to utter words, it uses them 



no HEARING, AND HOW TO KEEP IT. 

imperfectly from want of practice, and becomes, 
practically, a mute. In such cases, every endeavor 
must be made to induce a talking child to keep on 
talking, as will be shown in Part III. 

Disease of the Semicircular Canals. — These pecu- 
liar canals and their function have been alluded to 
on p. 54. When, therefore, these canals are diseased, 
their function would necessarily be impeded, perhaps 
destroyed, for the time being. Many curious dis- 
turbances in equilibrium and other symptoms, as 
described on p. 54, have been ascribed therefore to 
a disease in the labyrinth, and probably in these 
semicircular canals. But as their functions are not 
positively known, their diseases are, as a matter of 
course, not easily made out. It would be well, how- 
ever, for persons afflicted with ear-vertigo, (and some 
symptoms in the train will point to the ear, as at 
least partially affected,) to be careful not to im- 
agine that their symptoms are those of biliousness. 

It is very probable that many cases of aural vertigo 
are not due to disease in the labyrinth, and hence in 
no way connected with a disease in the semicircular 
canals. It may be said that aural vertigo, when due 
to disease in the labyrinth, /. e. in the internal ear, 
is accompanied with total deafness in the affected ear 
or ears. On the other hand, ear-vertigo, due to the 
presence of a foreign substance in the external ear or 
by derangements in the drum-cavity, is not attended 



DISEASES OF THE INTERNAL EAR. Ill 

with total deafness. The latter kind of aural vertigo 
is much more easily cured than the form in which 
the deafness is profound; nevertheless, even the 
more serious form is amenable to treatment. All 
kinds of aural vertigo are distinguishable from epi- 
lepsy, or fits, by the fact that in the former there is no 
loss of consciousness, while in the latter the patient 
becomes unconscious. 

The Deaf and Dumb. 

When a child is born deaf, or becomes deaf before 
it has learned to talk, it is said to be deaf and dumb, 
or a deaf-mute. In some instances the child is deaf 
from a disease which has also rendered it stupid 
intellectually ; but, as a rule, a child becomes a mute 
only because it has never heard the sounds of speech. 
In such cases, the child has no idea of what spoken 
language is. It was once supposed most mutes were 
born deaf; but this is not the case, one-half in some 
schools being known to have been born with the 
power to hear. 

We have already said that a blow on the head^ as 
from a fall, may entirely destroy the hearing while 
the child is a mere infant. This accident may be 
entirely forgotten, if it occur while the child is very 
young; but when it has reached the age when it 
ought to talk, the parents grow anxious, and then, 
upon being questioned, they recall the accident 



I I 2 HEARING, AND HO W TO KEEP IT. 

which, in all probability, destroyed the hearing of 
their child. 

But very often no such accident can be assigned as 
the cause of deaf-dumbness. However, it will then be 
found that the child had a severe attack of fever and, 
perhaps, convulsions in early infancy, or it may have 
had severe catarrh of the chest, or scarlet-fever, 
measles, or whooping-cough, with or without running 
from the ear. Any one of these may be the direct 
cause of deafness, and the child thus deprived of 
hearing cannot learn to talk. 

In some deaf and dumb children a running from 
the ear is known to have existed all their lives, and 
is still active when they are brought to the physician 
for examination. In others, again, the drum-head 
bears unmistakable evidence of disease, some of 
which, perhaps all of which, could have been cured 
if promptly treated. It is in such cases we see the 
folly of letting ear-diseases alone ^^to be outgrown.*' 
The disease may indeed cease without treatment, but 
before it departs it destroys the child's hearing. 

A child may grow deaf and dumb from an ear-dis- 
ease which has never produced any running from the 
ear. In such cases, the Eustachian tube becomes 
closed, and remains so until the drum-cavity is so 
long deprived of air as to lose entirely its function. 
In such cases, after a few years of closure, the drum 
can never be restored to health and hearing-power. 



DISEASES OF THE INTERNAL EAR. II3 

If a child be born deaf, its defect will soon become 
apparent by the insensibility it shows to noises when 
it is asleep. The jarring of its bed by direct blows, 
or from concussions in the street, may arouse it by 
shaking it, and this is misconstrued into its hearing 
such sounds. The mere fact that babes are so easily 
aroused by noises would show that very few are ever 
born deaf. Again, how soon a child learns its name 
if it can hear. If it never learns its name, or ceases 
to be attracted by its mention, then doubts may in- 
deed be entertained as to its hearing. 

Deaf-dumbness may be hereditary. The writer has 
seen this in a family where the mother was very deaf, 
all the children were deaf, and some of them so deaf, 
and at so early an age, as to be dumb. In such cases, 
there may be a grave doubt as to the propriety of 
members of such a family marrying, and thus running 
the risk of propagating a mute stock. This should 
be one of the considerations in the intermarriage of 
mutes or in the intermarriage of relations, especially 
if among the latter there should be either a tendency 
to deafness or to deaf-dumbness. When deaf-dumb- 
ness is plainly due to an accident or to disease in 
infancy, without there being any other cases of deaf- 
muteness in the family, nor any sign of a tendency to 
catarrhal deafness, there would be no danger of trans- 
mission of the defect to posterity, 
10* H 



PART III. 
General Hygiene of the Ear. 



CHAPTER I. 

THE CARE OF THE EAR IN HEALTH. 

EVER mindful of the object of this book to point 
especially to the prevention of disease and the 
preservation of the faculty of hearing, this last part 
of the work shall be devoted to a consideration of the 
care of the ear in health and in disease. 

As a rule, there is either too much toilet of the ears, 
or there is improper protection of them. On the 
other hand, there is most flagrant neglect of them, 
even in health ; the organs are unduly and carelessly 
exposed to bad weather and cold w^ater, and disease 
is thus brought on in what might have continued to 
be a perfectly good ear. 

The Auricle. — To begin with the auricle or out- 
side ear, it may be said that it should always gtt 
moderate and gentle washing with a wash-rag in 
preference to a sponge, and then a gentle and 
thorough drying. 

114 



THE CARE OF THE EAR IN HEAL TH I I 5 

Whenever it is desirable to protect the ears from 
cold air or a draught, it should be done by placing 
over them something that will sit lightly on them, and 
hence not bind them close to the head. A light and 
loosely-fitting cap is excellent for the protection of 
the ears as well as the bald heads of infants. But a 
tight cap will do their ears great harm by pressing 
the auricles against the head, causing not only 
increased perspiration, but, by thus binding down the 
ears to the perspiring surface, macerate the skin of 
the ears and set up disease like ** milk crust." 

Respecting the soap to be used about the ears not 
only of adults but of infants, it may be said that the 
best are the simplest. A good soap is not easily 
obtained. Perhaps a little Castile-soap is the safest 
for children. There is a very good soap called the 
*' Savon de Guimauve," a French soap, which is bland, 
cleansing, free from odor, and hence less liable to 
putrefaction. Any soap that sours easily should not 
be used about the ears, nor, in fact, used at all in 
personal toilet. Children's ears are, as a rule, not 
only too much washed, but very rudely and painfully 
washed, especially in the canal of the ear, as we shall 
speak of further on. 

If any one suffers from cold in or about the ears, a 
light ear-muff or a piece of cotton wool placed lightly 
in the ear, or ear-pieces from the cap, or a woollen 
scarf around the ears, will be sufficient protection. 



Il6 HEARING, AND HOW TO KEEP IT, 

In the case of women, a veil or hood will amply pro- 
tect the ears from cold. 

The ears may be protected from the smi by a broad 
brim to the hat or by a light cape falling from the cap, as 
in the so-called '' Havelock; " and this will also protect 
from the sting of insects. The latter covering, how- 
ever, is apt to be very warm in just the countries 
where it is most required for protection. A broad 
hat and a light net or veil will, in such lands, best 
meet the needs of the soldier or traveller. 

Piercing for Ear-rings demands a word of caution. 
It is usually done by jewelers, and consequently some 
important points may be unknown to them. 

In the first place, the instrument used for piercing 
the lobule should be thoroughly cleansed after each 
operation, otherwise a small quantity of animal 
matter may remain on it, undergo putrefaction, and 
thus poison the next person operated on. Diseases, 
too, could thus be communicated from one individual 
to another. Another point to remember is, that 
nothing but the soft lobule should be pierced. 
Where this is small or hard, the greatest care is neces- 
sary to insure against perforating the cartilage, which, 
in all probability, extends into the lobule as stated 
already. 

Ear-rings are sometimes torn from the lobule, thus 
causing a slit, which heals leaving an ugly deformity 
in the shape of a kind of double lobule. In one 



THE CARE OF THE EAR IN HEALTH. II7 

instance, the writer saw a lobule that had been torn 
twice, thus leaving two permanent slits in it and 
giving the ear a fringed appearance. After the wound 
is made, properly fitting together the raw edges would 
prevent the deformity ; but the latter once formed by 
healing wrong, can be corrected only by the surgeon's 
knife. 

A word of caution must therefore be given here 
respecting that most reprehensible custom of pulling 
children's ears in punishment. Though this practice 
is not as dangerous to hearing as one yet to be named 
when considering the drum-head, viz., '^boxing the 
ear," it is nevertheless open to great condemnation, 
as being not only cruel, but very likely to inflame the 
dense fibrous tissues holding the auricle in place. 
Such an inflammation, if not speedily checked, would 
lead to hardness of hearing, and, perhaps, perma- 
nent deafness. Should the bone entering into the 
frame-work of the ear, underlying these inflamed 
structures, also become involved in the aforesaid 
inflammation, results even fatal to life may ensue. 
The auricle is often subjected to considerable rough- 
ness in washing. This should be avoided, as it is not 
necessary to cleanliness, and often excites general 
inflammation of the part or local inflammation in 
the form of boils. After washing the auricle, great 
care should be taken to dry it thoroughly, and also 
the prominent bone behind it and the hair that, 



Il8 HEARING, AND HOW TO KEEP IT. 

in some persons, lies very near or even touches it. 
If any dampness is allowed to remain in or about the 
auricle, evaporation, as every one ought to know, 
reduces the temperature and renders the ear liable 
to ^^ catch cold," /. e. to become the seat of catarrh. 
The popular idea, therefore, that dashing cold water 
against the auricle, and even into the ear-canal, is 
healthful or strengthening to the organ, is wrong. 

Auditory Canal. — Of still greater importance is the 
hygiene of the auditory canal, — the canal leading 
down to the drum. Here we constantly meet with 
the bad results of too much washing, picking, scratch- 
ing, swabbing, etc. 

Referring to the anatomy and physiology of this 
part of the ear, we find that it is a canal lined with 
delicate skin, and, at its mouth, naturally smeared 
with ear-wax. The latter, therefore, is necessary to 
the health of the ear, or it would not be there by 
nature, and it must not therefore be looked upon as 
dirt. 

This canal must be unobstructed, yet well supplied 
with wax : the first, in order to transmit waves of 
sound to the drum-head; the second, to keep out 
insects and worms or any small living creature, and 
also to keep off the fungus Aspergillus, for the latter 
will not grow on healthy ear-wax. 

This apparent paradox in nature, the necessity for 
an open canal, and the presence of a gluey substance 



THE CARE OF THE EAR IN HEALTH. 1 19 

ever forming at its outer end, is reconciled by the 
fact that the skin of the ear grows outward and car^ 
ries superfluous ear-wax and dust with if. 

It needs no great powers of reasoning to see how 
easily most things that people do for their ears or put 
into them, in health, tend to interfere with the opera- 
tions of nature. So far as the entrance of cold air 
into the canal is concerned, it may be said that the 
peculiar spiral shape of this passage prevents the 
direct blowing of air upon the drum-head. . 

If, therefore, the ear-wax is to be looked upon as 
the natural protector of the ear and not as dirt, it 
should not be constantly and sedulously scraped away, 
as, unfortunately, it is in too many cases. All super- 
fluous ear-wax will fall from the ear in time if the 
organ is let alone. Hardening and packing in of 
wax in the ear is an artificial product, usually caused 
by the gradual packing in resulting from the patient's 
unsuccessful or partial endeavor to remove this im- 
portant substance from the ear. The skin of the 
auditory canal grows outward, and naturally carries 
with it scales of dead scurf-skin and old wax. It is 
very evident, therefore, that the use of any form of 
ear-picks, ear-spoons, and bougies, such as towel- 
corners rolled into cones, so-called ^^aurilaves,'' * of 
which too much can hardly be said in condemnation^ 

^ An *' auhlave " is a most condemnable instrument, made by 
fastening a piece of sponge to a bone handle. 



120 HEARING, AND HOW TO KEEP IT. 

is at direct variance with the mode of nature in 
emptying the ear of anything superfluous. All such 
endeavors at cleaning the ear will push in much more 
than is brought out. 

The cleanest people are generally those who pack 
the most wax back into their ears. A morbid idea of 
cleanliness leads them not only to swab their ears 
daily, but also to pour or drop into it a variety of 
fluids, as sweet-oil, glycerine, etc. 

Now, as has been said, all this treatment of the ear is 
subversive of the law of nature regarding the ear's 
welfare and comfort. More than this, it usually 
leads in time to positive inflammation. 

The scraping away of wax from the mouth of the 
auditory canal causes the ear to itch. This entails 
scratching ; and the latter is likely to abrade the skin 
or directly to inflame it. 

Abrasion may not only cause the ear to feel sore, 
but furnishes a moisture consisting of animal juices, 
which will quickly become putrescent, and thus favor 
the growth of a mould or fungus called the Aspergillus. 
The growth of this vegetable parasite in the ear leads 
to a stubborn and painful inflammation of the skin of 
the canal and of the drum-head. The latter part is 
especially sought out by the fungus, and its growth 
thereon not only inflames the drum and causes pain 
and hardness of hearing, but it has been known to 
penetrate the drum. 



THE CARE OF THE EAR IN HEALTH. 121 

The use of sweet-oil, glycerine, etc., has its evil 
results, too, even if the inordinate wiping or picking 
the ear is not indulged in. Sweet-oil, so constantly 
and popularly employed in aural diseases, has no 
virtues whatever in the treatment of ear-disease, but, 
on the contrary, possesses positively bad qualities as 
an application to the ear. Because, besides having 
no good solvent effect on wax, it clogs the ear, 
increases pain, and does harm by its tendency to 
become rancid. When once put into the ear, sweet- 
oil, or any other fat, is usually soon forgotten, and 
allowed to remain there until it is rancid. This sup- 
plies the fungus alluded to with a most encouraging 
soil in which to grow. 

Glycerine, too, has its ardent advocates, who con- 
sider it as bland as it looks. But glycerine has great 
affinity for water, and therefore acts like a caustic. 
Hence, glycerine, unless greatly diluted with water, 
when put into the ear, burns and stings until the ear 
is in the first stages of inflammation. There is no 
doubt that it possesses solvent power over ear-wax, 
but, when employed for this purpose, it should be 
well diluted with water, in the proportion of at least 
one to eight or ten. In such a preparation only, can 
it be, or has it ever been, of service, and then only 
as a solvent to a plug of ear-wax which, in all proba- 
bility, the patient had formed in his ear by his own 
meddling. 
II 



122 HEARING, AND HOW TO KEEP IT. 

As the auditory canal is the only external conduit 
to the ear, and also one easily got at by both physi- 
cian and patient, it has ever been a channel through 
which much deleterious matter has passed to the 
deeper parts of the ear, both before and since the 
time of Hamlet's father. It may be set down here 
as an axiom, that nothing should ever be put into the 
ear to cure toothache. This is a popular mode of 
treatment which constantly leads to injury of the organ 
of hearing, yet, so far as I know, never has cured a 
toothache. Not long since, there was removed by 
the writer, from the ear of a Swedish woman, three 
pepper-corns, which she had steeped in cologne water 
and placed in her ear sixteen years previous, for the 
cure of toothache. The latter passed off, as most tooth- 
aches will, in time, and the pepper-corns were forgot- 
ten. Years after this, a cold brought on a slight 
swelling in the skin of the auditory canal, and this, 
closing around the pepper-corns, which were almost 
equal in diameter to that of the auditory passage, 
greatly intensified the inflammation and excited the 
most violent pain, not only from the pressure of the 
skin upon them, but from their irritant qualities, 
which were once more brought out by the softening 
effect of the fluids which poured from the skin of the 
ear in its diseased state, and also by various matters 
dropped into the ear by the woman in her attempts 
to relieve her suffering. All such mismanagement of 



THE CARE OF THE EAR IN HEALTH. 1 23 

the hygiene of the ear inevitably leads to pain and 
injury. 

Still more common is the practice of putting almost 
numberless substances, chiefly fluid, into the ear for 
the cure of deafness. A laughable list might be given, 
consisting, in part, of such things as rabbit's fat, 
eagle's gall, neat's-foot oil, human urine, milk of 
women and of the cow, and vast numbers of* matters 
equally useless so far as remedying deafness is con- 
cerned. There is now and then a more serious aspect 
to such purely nonsensical treatment of the ear. The 
above-named articles, as a rule, do no harm, but when 
one individual succeeds in inducing another to pour 
boiling oil into the ear, as occurred -in a case which 
came under the writer's notice, then the utter folly 
of domestic treatment becomes apparent. 

The great danger attending scratching the auditory 
canal has been alluded to when speaking of injuries 
of the drum-head. It will therefore be hardly neces- 
sary to allude specially to the folly of such practices. 

Itching of the ear is at times intense, and the 
natural impulse is to scratch and relieve it ; but this 
must be done with the finger, or not at all. If this 
will not relieve it, hair-pins and pins must not be 
used to scratch the canal of the ear, for reasons 
already given. 

When itching of the ears keeps up, syringing with 
warm water may give relief; but usually there is some 



124 HEARING, AND HOW TO KEEP IT, 

diseased condition at the bottom of the annoyance, 
and the surgeon alone can give permanent relief. 

Already, many directions as to what should not be 
done have been given. A few words are therefore 
necessary as to what may be done in the form of 
hygiene of the auditory canal. The auricles may be 
protected in cold weather aiid in the open air by ear- 
muffs, a veil, or a scarf, and these also protect the 
auditory canal. This is preferable to protecting the 
latter by putting cotton in it. The latter is more 
convenient, and of course less visible. If the ear is 
free from discharge, and yet suffers from pain when- 
ever exposed to the cold air, a piece of cotton or 
wool may be worn lightly in the ear when in the open 
air — but only there and never in the house. The en- 
tire ear can be made tender by wearing cotton in it in 
the house, and its wax can be packed back by practis- 
ing such a habit; it is thus kept too warm, the cotton 
acts like a poultice, and the ear is then not un- 
commonly drawn to a running. It is also a dirty 
habit, for the cotton is not likely to be changed very 
often if worn constantly, and not uncommonly it is 
pushed into the ear and forgotten. Hardness of 
hearing is thus gradually brought on. 

Cotton may, however, be worn in swimming or 
diving, especially in the latter, in order to prevent 
the entrance of water into the ear. It is not easy, 
however, to keep it in the ear, unless it is held in by 
a cap of some kind. 



THE CARE OF THE EAR IN HEALTH 1 25 

Here, then, a caution must be inserted in order to 
further protect the ear and its functions. It does seem 
that a prolonged swim, or numerous repetitions of 
swimming in cold water, are more likely to produce 
inflammation of the ear, than a short and solitary in- 
dulgence in this summer sport. In addition to brevity 
of the bath, it would also be only safe to stop the ear 
with cotton during the swim. It is much better for 
boys and girls in a city to swim in a natatorium, where 
the water is never allowed to become cold. As for 
swimming every day in cold brook-water, as so many 
boys, and sometimes girls, in the country do, it is not 
only useless, but it is positively liable to injure both 
health and hearing. Bathing in the sea and surf has 
many points of danger to the ear, which must be noted. 
Prominent among these is the direct force of the waves 
and breakers, to which the ear may be exposed. A 
physician, a friend of the writer, while bathing in the 
sea, received a breaker against the side of his face and 
in his ear, resulting in a rupture of the drum and per- 
manently defective hearing. But these cases are com- 
mon in the experience of every surgeon who is em- 
ployed in observing ear-diseases. 

Other dangerous attendants of sea-bathing are the 
coldness and stimulating properties of the sea-water. 
In fact, so far as the ear is concerned, these two prop- 
erties of sea- water render it an irritant to the ear, and 
the number of cases of ear-disease, from slight ear- 
11^ 



126 HEARING, AND HOW TO KEEP IT. 

ache to a long-continued and painful inflammation of 
the ear, occurring at the seaside in summer-time, is 
something calling for attention not only on the part 
of the bathers, but of their medical advisers. 

This dangerous quality of sea-bathing is only one 
more argument against its now indiscriminate use, and 
the positive abuses to which it has come. The old 
idea that nobody can catch cold, either in or out of the 
water, at the sea-shore, has been exploded long ago, 
in the minds of physicians of any experience along 
our coast, and should be extirpated from the minds 
of the public as soon as possible. A short bath once 
or twice a week may be a good tonic in some cases, 
if it is enjoyed ; but as for staying in the surf until 
ears and lips, as well as fingers and toes are livid, as 
many, chiefly women, do, it is self-evident that ca- 
tarrhs of all kinds must prevail among sea-side bathers, 
as in fact such diseases do. Fine swimmers remain 
in the surf, as is well known, for hours. Not long 
since, the writer was consulted by one of these phe- 
nomenal swimmers, who had remained one hour and 
forty minutes, swimming up and down the surf at 
Cape May. The surf was high, and the water was 
cold — it was in June ; and the result of this indul- 
gence in the bath was a severe inflammation of the 
drum, for the water had entered the ear most exposed 
to the direction of the surf, constantly and with some 
discomfort to the patient, while in the water. In all 



THE CARE OF THE EAR IN HEALTH 12/ 

cases of sea-side bathing, if it is likely that the head 
of the bather is going under the surface of the water, 
the ear should be protected by cotton, held in posi- 
tion by an oiled silk cap. 

After coming from the bath, the old idea that they 
cannot take cold is followed out by the bathers, and 
they sit about in draughts, the ladies taking this oppor- 
tunity to dry their hair. This practice leads con- 
stantly to colds, and not uncommonly to earache. 
The sea-side is the place where perhaps one easily 
takes cold in all parts of the body. 

In fact, it is to be hoped that the day is not far 
hence when it shall be a rare exception to see men, 
women, and children bathing in the surf. It is 
desirable that the salt water bath should be taken in 
a private bath-house, either in or near the hotel, 
where the temperature can be made to assure not only 
comfort, but in some cases the demands of health. 
The establishment of the latter custom would not only 
be vastly more judicious, so far as the health of the 
body and the welfare of the ear are concerned, but it 
would do away with much that is grotesque in dress 
and immodest in behavior. 

Too much in praise of the sea-air as a tonic to 
health, and hence to those affected with ear-diseases 
of all kinds, cannot be said. We do not wish to be 
misunderstood on this point, for we have seen good 
results in ear-diseases from a residence at the sea- 



128 HEARING, AND HOW TO KEEP IT. 

side, but without the daily cold-water bath, — for 
reasons already given. "^ 

Effects of Alcoholic Drinks and Tobacco on the 
Ear. — It has often been urged that both of these very 
useful things are injurious to the hearing as well as to 
other important senses of the body. Their abuse 
certainly is injurious to the ear as well as to the entire 
body and its organs of special sense. 

So far as the ear is concerned, it may be said that 
the undue use of alcohol will injure the hearing in 
two ways, viz., by inflaming the throat, and thence the 
Eustachian tube and middle ear, and also by a con- 
gestion of the internal ear. It is therefore not ad- 
visable to use it when the ear is acutely inflamed. 

Tobacco in all forms has received great condemna- 
tion from aurists. Smoking is the least objectionable; 
but chewing and snufling are, without doubt, more 
likely to produce, respectively, catarrh of the throat 
and nose, and hence ear-disease and deafness. But 
moderate smoking of cigars — not cigarettes — cannot 
be shown to be injurious to hearing. Women who 
have never smoked become deaf at the same age and 
to the same degree as their brothers or fathers, who 
have smoked, and continue to do so, without any 

* The injuries done to the ear by improper bathing, and cold 
bathing in summer, are graphically shown in a paper by Dr. 
Samuel Sexton, of New York city, in N. Y. Medical Record 
of May 4, 1878. 



THE CARE OF THE EAR IN HEALTH. 1 29 

demonstrable effect on their deafness. In all cases, 
however, it may be dangerous to hearing to blow the 
smoke through the nose, as in that act the smoke is 
brought directly to the mouth of the Eustachian tube, 
and may set up irritation there. As cigarette smoke 
is usually thus blown out, this may be the reason of its 
supposed greater harmfulness to the ears. 

Perhaps, too, the fumes of the paper-covering of 
the cigarette may have an especially injurious effect 
on the ears. With this proviso, that no smoke should 
be blown through the nose, a person deaf or only 
hard of hearing may be allowed to smoke say one 
cigar after each meal. A very important considera- 
tion in this question of smoking and its effects on the 
ears, is the time and place for the indulgence. An 
atmosphere loaded with tobacco-smoke is more injuri- 
ous than a smoke in a properly-ventilated roon ; and 
spending an entire evening in a crowded restaurant 
or club-room filled with smoke, is very bad for all 
kinds of catarrh, especially for catarrh of the throat, 
nose, and ears. 

Effects of Great Noises on the Ear, — We have 
already alluded to the effects of sudden and powerful 
concussions on the ear. These occurrences as alluded 
to are mostly purely accidental, and hence unavoida- 
ble. But there are some noises which may do harm 
to the ear, and yet can be avoided ; as, for example, 
shouting suddenly in a person's ear. This is not only 

I 



130 HEARING, AND HOW TO KEEP IT, 

a cowardly act, but one which, coming suddenly on 
the individual and on the ear entirely unprepared for 
the shock, may result in permanent deafness. The 
shock to the nervous system is also very great and 
often disastrous. 

Closely akin to this in effect is the constant clatter 
of machinery. This can best be guarded against by 
wearing something over or in the ear when exposed 
to such sounds. Boiler-makers are especially exposed 
to the bad effects of noises on the ear. 

The nerve- power seems to be at last exhausted by 
the excessive and constant noise to which it is sub- 
jected. In the end, the result is similar to that pro- 
duced by a great blow or fall on the head. 



CHAPTER II. 

THE CARE OF THE EAR IN DISEASE, INCLUDING 
THE RELIEF OF PARTIAL DEAFNESS AND THE 
EDUCATION OF PARTIALLY DEAF CHILDREN AND 
DEAF-MUTES. 



The Care of the Ear in Disease. 

THE care of the ear in diseased conditions would 
naturally be considered as treatment of the vari- 
ous diseases which may affect it. And, in fact, some 
allusion as to the best treatment has been made when 
speaking of the diseases of the ear, and also in what 
has been said about what should not be done. But 
there still remain some general directions which might 
be followed out with great benefit in a number of dif- 
ferent diseases of the ear. 

The Auricle. — Thus, for instance, in a large num- 
ber of diseases of the auricle, some directions as to 
washing this part of the ear may be given with ad- 
vantage to the sufferer. 

In the acute and painful inflammations of the skin 
of the auricle, it will be found that washing it with 

131 



132 HEARING, AND HOW TO KEEP IT. 

soap and water, or with water alone, will do more 
harm than good. When the skin is red, swollen, 
hot, and stinging, and perhaps broken and weeping, 
it will be found that to dust over it some finely pow- 
dered starch, or to smear it over with a bland mucil- 
age of slippery elm or quince seed, or a bland oil, 
like sweet-oil, will give the most relief, until a physi- 
cian can be called to prescribe other remedies. 

So long as the inflammation of the auricle is lim- 
ited to that part, no fears for the welfare of the hear- 
ing need be entertained ; but watchfulness, lest the 
disease should spread to the auditory canal and drum, 
should always be maintained. 

Auditory Canal. — When the ear runs, as it often 
does in children, no cotton, nor any such substance, 
should be worn in the auricle or the auditory canal, 
for it not only keeps in the discharging matter, but 
helps to further inflame the ear. It may be well said 
that it is ^^too heating." 

The discharge from an ear should be removed as fast 
as possible, usually by the syringe, otherwise the odor 
from the ear becomes intolerable. Even when using a 
syringe regularly, sometimes the ear cannot be kept from 
smelling badly. To plug it up with cotton, as many 
very well-disposed parents do, is to dam up the pus, 
or mucus, coming from the deeper parts of the ear, and 
to make the ear smell more than it otherwise would. 
The cotton soon gets soaked with matter which rap- 



THE CARE OF THE EAR IN DISEASE. 1 33 

idly putrefies; this soaked pellet of cotton softens and 
irritates the parts of the ear it touches, and the wel- 
fare of the ear and the comfort of patient and his 
neighbors are endangered. It is thus that most of 
the cases of eczema^ or tetter, are excited in the ear. 
When the latter disease invades the canal, as it does 
not uncommonly, the patient usually makes the dis- 
ease rapidly worse by rubbing up the corner of a 
towel or wash-rag, soaping it well, and running it down 
the canal as far as possible. This not only increases 
the disease, but packs in the cast-off matter, and lays 
the foundation of a soil most fruitful for the growth 
of the fungus Aspergillus. 

The syringe is the only proper means of cleaning the 
ear, if the ear must be cleaned, and directions for its 
proper use have been given on p. 62. It would indeed 
be better for a number of children, as well as adults, 
if nothing but the syringe and warm water had been 
used in the domestic treatment of their ear-diseases. 
But, on the contrary, as soon as any one, child or 
adult, is affected with aural disease of any kind, every 
one in the circle of his acquaintance has some non- 
sensical remedy to suggest. These are usually in the 
form of ^'drops'' of some kind of oil, than which 
nothing could be worse for the ear. It had better be 
let entirely alone, than that oil of any kind should be 
put into it. Oil will not dissolve ear-wax, therefore it 
will do no good when the wax gets plugged in the ear. 



134 HEARING, AND HOW TO KEEP IT. 

The folly as well as the harm of using it in other dis- 
eases of the external, has already been alluded to, 
and the utter impossibility of reaching the middle 
ear, with oil dropped into the external ear, is shown 
from the anatomy of this part of the ear. 

The properly educated physician is the only one 
who can tell what is the nature of the ear- disease, and 
what should be done for it. The ear had indeed 
better be let alone, than that the wrong thing should 
be done for it. 

It has always seemed so strange to the writer, that 
any old woman's remedy is preferred by those affected 
with aural disease. There was never such a remedy 
yet advised that was not folly and injury combined, 
and yet it is readily accepted and followed, while 
any advice the surgeon may give, is often looked on 
with suspicion, after the patient's mind has been de- 
luded by ''old wives'' fables y 

A person afflicted with ear -disease should be very 
careful not to get the feet wet, nor to expose the body 
incautiously to great changes in temperature. In 
public places of amusement or instruction, a seat 
should be chosen out of draughts. Upon entering 
such places, the outer wrappings, furs, overcoats, and 
the like, should be removed. If this is not possible, 
then an extra shawl, or covering of some kind, should 
be carried on the arm to the hall, to be put on over 
the wrappings on leaving the audience-room. Always, 



THE CARE OF THE EAR IN DISEASE, 1 35 

upon leaving warm audience-halls of any kind in the 
winter season, great care should be taken by every 
one to protect the heated and fatigued body from 
cold. 

There is nothing more injurious to hearing — espe- 
cially poor hearing — than chilling of the body, the 
feet or the head. 

A sedentary or secluded life is also injurious to 
hearing. Any one partially deaf should avoid, if 
possible, close confinement of any kind. Hard study 
and the neglect of pleasant companionship will tend 
to make the hearing worse, as will all depressing influ- 
ences, like nursing the sick, or the indulgence in im- 
moderate grief. Natural feeling in sorrow cannot be 
suppressed, but weeping is very depressing to the hear- 
ing, as well as other functions of the body. All these 
facts should be borne in mind by any one affected in 
hearing, and the effort should be made to avoid any^ 
thing which would tend to make the ear-disease worse. 

The young, when affected in hearing, should not be 
permitted to retire from society, but should be most 
carefully induced to act like others- of their age and 
social position. It might be said here, that when danc- 
ing is indulged in, great care should be taken that chill- 
ing does not occur, from exposure of the patient to cold 
night-air while the body is still very much heated. It 
should ever be remembered that at best the body is 
weaker as the night advances, and is a ready prey to 



136 HEARING, AND HOW TO KEEP IT, 

treacherous diseases, like catarrhs. The latter are 
especially injurious to the ears. 

There yet remains a word to be said about the 
clothing, bathing, and sleeping attire and apartments 
of those hard of hearing. The under-clothing is of 
the highest consideration, and should be worn of a 
heavy kind by both sexes. The partially deaf should 
defy the cold by their heavy clothing. So far as 
concerns the feet, they should always be protected by 
heavy shoes, and in winter-time by rubbers. The 
latter are the only sure protection against moisture, 
and they keep the feet warmer than leather shoes. 
The latter may be comparatively light, if arctics or 
rubbers of some kind are worn. If they should cause 
the feet to perspire, the stockings should be changed 
in the middle of the day for dry ones. This should 
be done, in most cases, by every one, whether af- 
fected with ear-disease or not. 

Great injury to the ears arises from the cold plunge- 
or the cold sponge-bath, especially if the ears get water 
in them ; furthermore, the chilling of the body, which 
is sure to take place if a glow is not felt immediately 
after the bath, is likely to act unfavorably on the ears, 
especially in catarrhal ear-disease and deafness. It 
is in such cases that the mistaken idea of hardening 
the body and the ears is shown. Cold water must 
never enter the ears nor the nostrils, if it can be kept 
out. 



THE CARE OF THE EAR IN DISEASE. 1 37 

The person affected with deafness, especially that 
arising from catarrhal disease in the throat, nose, and 
middle ear, should not sleep without an undershirt, 
nor in a draught. If the room is large and the 
patient sleeps alone, the windows should be closed in 
cold weather, and ventilation sought through an 
adjoining room. If the room is rendered close by 
more than one person's presence during sleeping 
hours, great care should be taken that the matter of 
ventilation is not overdone, as it is apt to be in our 
country, by allowing too much air to enter the apart- 
ments. I know that we hear a good deal about 
*^ hardening" people or making them *^ tender," but 
the former is not accomplished by sleeping in the 
cold, nor will being comfortable make them weak 
and delicate. All these attentions are demanded in 
the case of children. 

In them, especially the younger ones, from one 
year to eight or ten, deafness is often attended with 
disease and stoppage of the nose. The child then 
breathes through its mouth. This, as already said 
(p. 95), is very injurious to the throat and ears, the 
chest, and the general health and development of the 
body. 

The child's enunciation is ruined by it, causing 
him to ^^talk through his nose," as it is termed; but 
in reality that is just what it does not do, for his 
nose is stopped up. The nasal sounds are lost from 



138 HEARING, AND HOW TO KEEP IT, 

his speech, and hence the peculiar and disagreeable 
twang to his voice. 

His nose collapses and looks pinched, the expres- 
sion of the upper lip is spoiled, and his face, thus 
being altered, becomes foolish and stupid-looking. 
The nose is a kind of sifter of the air breathed 
through it, and it also warms the air we draw through 
it before it enters the lungs. This advantage is lost 
if the nose is stopped up. 

At night the child chokes from dryness of the 
throat, and snores because forced to sleep with his 
mouth open. His rest is disturbed, his health fails, 
and his hearing grows worse. 

Even after the obstructions are removed, either by- 
nature or by art, the child may have learned a bad 
habit of breathing through its mouth. This must be 
looked after, and the child, if old enough, must be 
reminded to breathe through its nose. Much can be 
overcome by thus correcting the child from time to 
time. It is good for the ears, as it ventilates them, 
to oblige the child regularly, three or four times a 
day, to close his lips and breathe forcibly through his 
nostrils for several minutes. This cleans the nostrils, 
and brings to them the natural tonic of breathing air 
through them into the throat and lungs. 

It is absolutely necessary to the health of the nos- 
trils to breathe air through them, for that is their 
function ; but it is just as unnatural and injurious to 



THE CARE OF THE EAR IN DISEASE. 1 39 

snuff up water into them. A moment's reflection 
will show that they are air-passages and not water- 
conductors. 

Hence, in applying liquid medication to or through 
the nostrils, it should always be warmed, and never 
snuffed hard into the nostrils, but it should be rather 
poured into first one and then the other nostril, until 
it is felt gently trickling into the throat. But nothing 
which causes pain, stinging, or tingling in the nos- 
trils should be used in them as medicine. 

If the patient applies nothing to his nostrils or 
ears without the advice of an intelligent physician, 
no danger will be likely to occur from treatment ap- 
plied to these parts. 

Hearing- Trumpets. — A child is rarely obliged to 
use a speaking- or hearing-trumpet, although many a 
child might be kept from becoming a deaf-mute, if he 
were taught to speak by using some form of trumpet 
to aid him in hearing. 

There are many adults, however, who, from the in- 
curable nature of their deafness, are obliged, or should 
be obliged, to use a hearing-trumpet. Such an aid to 
hearing is not only an advantage to them, but a great 
comfort to their friends, as it saves the latter a painful 
effort to talk. 

What form of hearing-trumpet is the best cannot 
be described here, as different patients require differ- 
ent forms of trumpets, tubes, etc. The best plan for 



I40 HEARING, AND HOW TO KEEP IT. 

a deaf person to adopt in choosing this instrument 
is to go to a reliable instrument maker, and try the 
samples until he finds one that makes him hear well. 
Some kinds of deafness, as those where the nerve is 
paralyzed by a blow on the head or by disease in the 
brain, no trumpet can help. 

All instruments of any value must, from the nature 
of acoustics, have a certain size, and hence must be 
plainly visible ; otherwise they will not augment the 
sound by resonance. Hence, all invisible auricles, 
etc., are self-evident frauds, as they are too small to 
augment sound. The very small gold and silver 
tubes, or '^auricles," as they are called, are very ex- 
pensive, and, save in the collapse of the auditory canal 
in old people, are utterly useless. 

They are, in fact, worse than useless in all cases 
but those mentioned, since they fill up the ear and 
render the patient deafer. 

False drums act in the same way excepting where the 
natural drum is perforated. To employ them, there- 
fore, in catarrhal deafness, when the natural drum is 
thicker than usual, is, of course, to make matters worse. 
It amounts to filling the ear with a foreign obstruction, 

Education of Partially Deaf Childreii and Deaf- 

Mutes. 
Deaf Children. — There is a large number of deaf 
children who are by no means deaf and dumb, hav- 



THE CARE OF THE EAR IN DISEASE, I4I 

ing lost their hearing after they had learned to talk. 
After a child has once learned to talk, no matter how 
deaf it may become, it should be encouraged in every 
way to continue to use speech, and not signs, in com- 
municating with friends and family. In order to 
induce him to continue to speak, his signs must be 
disregarded. All children who grow deaf, will soon 
begin to make signs, and unfortunately the latter are 
encouraged by being answered in the same way. It 
would be very easy to make such a child look at the 
mouth and understand the signs made by the lips. 

But many children are too hard of hearing to es- 
cape being under disadvantages at ordinary schools, 
where they are competing with hearing-children. 
Such children, on account of their bad hearing, are 
often imposed upon both by companions and in- 
structors. Do as they may, such children must fall 
behind in their studies. But it is not desirable to iso- 
late these unfortunate children in separate classes, 
because it not only draws painful attention to them, 
but it is highly desirable that they should continue 
their studies among those with whom their lives are 
to be spent. 

Nevertheless, some allowance should be made for 
their defective hearing. The first step in this direc- 
tion is to find out whether the child is deaf or inat- 
tentive ; if he is deaf, he surely cannot fail to be 
inattentive. A child is, as a rule, unaware of its de- 



142 HEARING, AND HOW TO KEEP IT. 

fective hearing, especially a young child at the begin- 
ning of his deafness ; it is therefore the duty of his 
elders to find out and determine the amount of his 
deficiency. It can be expressed accurately in feet and 
inches. 

Dr. C. J. Blake, of Boston, has shown that of 8715 
cases of ear-disease, 2175, or 25 per cent., were chil- 
dren under 14 years of age, all of whom were pupils 
in the public schools. 

In such children, the distance at which they can 
hear the teacher's voice, should be carefully measured 
by testing with words and sentences, and there they 
should sit, the children with good hearing being 
placed farthest off. 

Nothing but the teacher's voice should be used, and 
that in ordinary tones in these tests, for the child goes 
to school to hear those sounds.''' 

Education of the Deaf and Dumb. — Physicians are 
constantly called on to decide whether a child is deaf 

* See Dr. Sexton's views in editorial notice in the N. Y. Med. 
Record, March 15, 1879. ^ careful, scientific examination 
would often reveal that some children in every school were 
suffering from disease of the ear and deafness, entirely curable, 
if taken in time. By being properly taken care of, they would 
regain not only hearing, but they would learn more at school, 
and would be enabled to get rid of a disease of the ear, which 
would otherwise grow worse, and finally, becoming irremedia- 
ble, render them permanently deaf. There is no greater fallacy 
in the public mind than that a child " will outgrow deafness." 



THE CARE OF THE EAR IN DISEASE, 1 43 

and dumb, and if it be, to suggest a cure if possible, 
and if not, to advise a plan for the proper education 
of the little patient. In very young children, it can- 
not always be readily decided whether total deafness, 
and hence prospective dumbness, exists or not. With- 
out being obliged to determine whether the child is 
totally deaf, a physician may find, on examination, 
that it is too deaf to learn to talk by hearing others 
speak, and without losing further time, he should ad- 
vise its parents to arrange for its proper education in 
another way. The education of deaf-mutes is accom- 
plished in two ways, viz., by the use of signs, '^finger 
language,'* and by the use of ^Mip-reading " and by 
phonetic writing, or visible speech. 

Before describing any of these methods of educa- 
tion of deaf-mutes, it must be borne in mind by the 
reader, that it is not the object of this book to advo- 
cate any one method to the exclusion of the others. 
It is believed that all have advantages and disadvan- 
tages. The only object in alluding to these various 
methods, is to let parents know what can be done for 
their children afflicted with deaf-dumbness. 

The sign-language is the most common form of 
communication in the institutions for the mute in 
this country. It has been found that when this form 
of language is used, no other method can be success- 
fully introduced at the same time. 

Lip-reading, /. e, the ability on the part of the 



144 HEARING, AND HOW TO KEEP IT. 

mute to understand what is said to him, by watching 
the lips of the speaker, is taught very largely in Ger- 
many, and is often called the German method. By 
this system, also, the dumb are taught to speak as well 
as to understand speech. 

Their articulation, of course, is not like ours, being 
peculiar and unnatural in sound, yet entirely intelli- 
gible. The writer has conversed in ordinary tones, in 
German, with German deaf and dumb children in 
Vienna, and was perfectly understood by them, the 
children replying in German that they perceived he 
was a foreigner, so delicate was their perception of 
the motion of the lips. 

Phonetic writing, or visible speech, the system of 
A. Melville Bell, is based on the physiological action 
and position of the vocal organs during speech, and 
is practically an alphabet of sounds, in which the 
symbols, either printed or written on the black-board, 
inform the child how to place its lips, tongue, and 
palate, and produce a vocal sound. It has been suc- 
cessfully employed in England and in this country. 
Lip-reading and visible speech may be of great value 
in the education of children who have become deaf 
after having learned to talk in the first four or five 
years of life. Their conception of what speech is, 
and their ability to use it, are invaluable aids in their 
further education by means of lip-reading and articu- 
lation, or by visible speech. 



THE CARE OF THE EAR IN DISEASE. 1 45 

Hence, no matter how deaf a child may become 
after it has once learned to talk, it should be discour- 
aged in the use of dumb signs, and encouraged to go 
on talking. 

It is desirable that a mute who is to be taught 
lip-reading and talking should begin his exercises 
before he is seven years old. It will then require 
about eight years of study and practice in this way, 
but at the end of that time he will be able in most 
cases to converse with and understand any one he 
meets. In some instances, mutes thus educated can 
converse in several languages. 
13 K 



INDEX 



Abscesses in the ear 
Alcoholic drinks, effects on ear 
Anvil (Incus) 

Artificial or "false" drums 
Auditory bones, leverage of 
Auditory canal . 

abscesses in 

■ boils and fungus in 

bone-tumors of 

care of, in disease 

— - — care of, in health 

diseases of . 

foreign bodies in 

insects in 

■ neuralgia of . 

physiology of 

syringing 

wax-glands . 

Auricle . 

— — care of, in health 

care of, in disease 

diseases of . 

imperfect development 

in Egyptians 



PAGE 

64 
128 

22 



15 
64 
64 

66 
132 
118 

59 
59 
62 

65 
46 
62 
16 
12 
114 

131 

56 
5^ 
15 



146 



INDEX. 



Auricle, physiognomy of 

physiology of . 

position of . 

points in 

Boils and fungus in the ear 
Bonelets of ear . 
Bone-tumors . . . 

Boundaries of drum 
Boxes on the ear 



147 

PAGE 

44 
15 
15 

64 

22 
66 
26 
68 



Canal, auditory 15 

Care of ear in disease 131 

Catarrh, chronic 89-96 

Catarrh explained . . . . . . . -91 

Catarrh-snuffs ........ 95 

Chain of bones 22, 23 

Chronic catarrh of the ear . . . " . . . 89-96 

Chronic deafness, with discharge .... 86, 87 

" " without discharge .... '^^ 

Clang-tint ......... 42 

Cochlea 34 

Cochlear nerve ........ 38 

Cold bathing, effect on ears .... 72, 73, 136 

Concussion, effects on ear .108 

Corti's arches . . 39* 40 

Corti's organ ......... 38 

Cotton, use and misuse of, in ear . . . . 124 



Deafness, chronic, with discharge from ear ... 86 

" " without discharge from ear . . 88 

Deaf and dumb ....... ill, 113 

education of ....... 142 



148 



INDEX, 



Disease, Meniere's . 

of semicircular canals . 

Diseases of auditory canal 

of auricle . . . • . 

of drum-head 

of Eustachian tiibe 

of middle ear 

Dizziness in ear-disease 
Drum ..... 
Drum, boundaries of . 
Drum-cavity .... 
Drum-head (membrana tympani) 

diseases of . . . 

diseases of from cold bathing 

flaccid part 

folds of ... . 

physiology 



Earache ..... 
Ear, at sea-side .... 
boxing and pulling - . 

care of, in disease . 

care of, in health 

cold water on ... 

disease, dizziness in 

effects of alcohol and tobacco on 

effects of great noises on the 

effects of swimming 

in sea bathing 

itching in ... . 

internal .... 

middle ..... 

muffs ..... 



the 



INDEX. 149 

PAGE 

Ear-rings, piercing for 116 

structure of . 9 

tetter of . . 133 

vertigo ........ 105 

vertigo, from brain- tumor . . . . .107 

wax . . . . . . . . . 120 

Eustachian tube . . . . . . . 31, 32 

diseases 95 

physiology 50 

External ear 10 

Folds of drum-head 21 

Foreign bodies in the ear ...... 59 

Fungus or mould m the ear 73 



Giotto 

Glycerine, misuse of 



15 
121 



Hammer . 22-24 

Hearing . . -43 

Hearing-trumpets . . . . . . . 139 



Incus (anvil) 22 



Injuries of drum-head 
Injuries of middle ear 
Insects in the ear 
Intensity of sound . 
Internal ear 

cochlea 

cochlear nerve . 

concussion 

Corti's organ 

labyrinth 

13* 



67 

. 77 
62 

. 42 
II 

34-36 
38 

. 108 
38 



ISO 



INDEX. 



Internal ear, physiology of . 
semicircular canals 

Labyrintli, or internal ear 

Labyrinth (membranous) 

Lancing the drum . 

Leverage of auditory bones 

Lip-reading 

Lobule . . . . 



PAGE 

• 35 

33-40 

37 
. 82 

21 
. 143 

13 



Malleus .... 

Mastoid cells .... 
Membrana tympani, or drum-head 

dimensions, etc. . 

Membranous labyrinth 

Meniere's disease 

Middle ear .... 

artificial drums . 

chronic catarrh of . 

chronic deafness without discharge from ear 

chronic deafness with a discharge from ear 

diseases and injuries . 

earache .... 

lancing the drum 

poultices over ear . 

running from 

what not to do in disease 

Muscle, stretcher of drum . 



Nasal douche 
Neuralgia in the ear 



22 

33>5i 
. 16 

18-21 

• Zl 
105 

21 

88 
89-96 

%Z 
86,87 

77 
77,78 

82 
. 85 
79,80 
83,84 

27 

93 
. 65 



Over-tones 



42 



INDEX. 

Partially deaf children, education of 
Physics and physiology of sound 
Physiognomy of auricle . 
Physiology of auditory canal 

auricle . 

— — drum-head . 

Eustachian tube 

hearing 

internal ear 

mastoid cells 

sound .... 

tympanic, or drum-cavity 

Pitch (sound) 

Poultices over the ear 

Promontory 

Pyramid and cone of light 



41 



PAGE 
140 

41 
14 
46 

44 
47 
50 
43 
52 

51 

42 

49 
42 

85 
30 
19 



Quality, or clang-tint 



42 



Running from the ear 
Rupture of drum 



79,80 
67-69 



Savon de Guimauve (soap) . 
Sea-bathing, effects of 
Semicircular canals 

disease of . . . 

Short process of hammer- bone 

Skin diseases of auricle . 

Soap ...... 

Sound ..... 

intensity, pitch, and quality . 

physics, and physiology . 

Stapes, or stirrup-bone 



115 

125 
35 

no 
20 
58 

"5 
41 
42 

• 41 
22, 24, 25 



152 INDEX, 

PAGE 

Stopped-up nose, effects of on ear . . . ' ^Zl 

Swabbing the ear ....... 74, 75 

Sweet-oil and glycerine . . . . . . .121 

Swimming, effects on ear . . . . . . 125 

Syringing the ear ........ 62 

Tensor tympani muscle ...... 27 

Tetter of ear ......... 133 

Tobacco, effects on ear . . . . . . 128 

Vertigo from ear-disease . . . . . .105 

Vestibule and semicircular canals .... 53 

Visible speech 144 

Walls of drum . , 27-31 

Wax-glands . . . . . . . . .16 

What not to do in ear-disease ..... Z^, 84 



THE END. 



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THOMPSON ON COUGHS AND COLDS. Their Causes, etc 50 

WYTHE'S MICROSCOPISTS' MANUAL. With Numerous Colored and 
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MATHIAS' RULES OF ORDER for Conducting Business at Town, Ward, 

Public, and Society Meetings 50 



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